Cleveland and Hamilton, Ontario—Among inpatients aged 45 years or older having noncardiac surgery, 9% will experience myocardial injury within the 30 days after the procedure. About 80% of these injuries are clinically silent, detected only by troponin elevation. Mortality, however, is nearly identical for symptomatic and asymptomatic troponin elevations. Within 30 days of surgery, 10% of patients with elevated troponin concentrations will die, making myocardial injury the leading