Multiple studies have shown that > 10% of patients > 65 years and undergoing non-cardiac surgery have an increase in Troponin T (TnT). In the POISE study including 8331 patients, the authors found that 5.7% of the placebo group suffered from a myocardial injury within the 30-day postoperative period. In the recently published data from the VISION study including > 15,000 patients, the authors demonstrated that patients with peak perioperative TnT values of < 0.01, 0.02, 0.03-0.29 and > 0.30 ng/L had a 30-day mortality of 1%, 4%, 9.3% and 16.9% respectively. Furthermore, an elevated TnT without symptoms or ECG changes are an independent predictor of 30-day mortality. It is possible that some cases of myocardial injury in Non-cardiac surgery (MINS) result from oxygen supply-delivery mismatch due to severe perioperative hypotension, and possibly persistent tachycardia but coronary artery thrombosis cannot be excluded in these patients. It is well known that surgical trauma causes an increase in several pro-inflammatory cytokines which, together with sympathetic over-activity, leads to a hypercoagulable state due to platelet activation, and a predisposition to thrombosis. In one study, it was found that approximately 1/3 of the patients had evidence of intracoronary thrombosis at autopsy.