Over the past 35 yr, approximately 100 outcome studies have examined the problem of PCM in patients undergoing noncardiac surgery. Most have focused on preoperative historical predictors, of which only a recent MI or present CHF are proven predictors of PCM. The efficacy and cost-effectiveness of specialized preoperative cardiac testing, such as exercise stress testing or dipyridamole-thallium imaging, remain controversial. Outcome studies of intraoperative predictors have shown that anaesthetic choice does not affect outcome, but that emergency surgery, major vascular surgery, and prolonged thoracic or upper abdominal surgery are associated with increased risk. Among the dynamic intraoperative risk factors, hypotension and tachycardia appear to predict outcome. Myocardial ischaemia, although potentially important, has not been studied rigorously in patients undergoing noncardiac surgery. Studies of the postoperative period are few. Preliminary data suggest that postoperative risk factors for PCM may be at least as critical as intraoperative factors. There appears to be a high incidence of haemodynamic stresses and of myocardial ischaemia during the postoperative period. However, the relationship of postoperative ischaemia to outcome is, as yet, unknown.