Predicting acute cardiovascular ischemic events is a crucial and urgent issue in the current cardiovascular field. An enormous effort to develop methodologies to achieve this purpose is being undertaken in cardiovascular institutes worldwide. However, currently, there is no established method of determining acute cardiovascular ischemic events in advance. This article reviews the latest progress on understanding how these events occur and how they can be detected. This goal represents a great dream that has realistic expectations. (Circ J 2011; 75: 2019-2026)