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Myocardial injury in noncardiac surgery. Myocardial injury is defined as an elevation of cardiac troponin (cTn) without requiring an ischemic symptom. Robust evidences suggest that myocardial injury increases postoperative mortality of noncardiac surgery. The diagnostic criteria of myocardial injury after noncardiac surgery (MINS) include an elevation of cTn within 30 days after surgery without an evidence of non-ischemic etiology. The majority of MINS does not present ischemic symptom and is caused by oxygen supply-demand mismatch. Predictive models for general cardiac risk stratification can be considered for MINS. The risk factors include comorbidities, anemia, glucose level, and intraoperative blood pressure. Modifiable factors may be helpful in preventing MINS, but further investigation will be needed. Recent guidelines recommend a routine monitoring of cTn during postoperative 48 hours in high-risk patients because MINS occurs mostly during the first 3 days after surgery without symptom. The use of cardiovascular drugs such as aspirin, antihypertensive drugs, and statin has shown to be beneficial in MINS patients, and direct oral anticoagulant reduced MINS mortality in a randomized trial. Myocardial injury detected before noncardiac surgery also showed an association with postoperative mortality, and more studies are required.