We provide the first translational report—from basic discovery to clinical assessment—that circulating IGFBP-3 is responsive to acute cardiac ischaemia (without necrosis) and that ΔIGFBP-3 has the potential to aid decision-making with regard to the need for imaging to detect significant coronary stenosis or the need to submit individuals for cardiac stress testing. The gene discussed is IGFBP3; the disease is ischemia.