The Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators W ORLDWIDE, MORE THAN 200 million adults have major noncardiac sur-gery annually. 1,2 Despite benefits associated with surgery, major perioperative complications, including death, occur. 3 More than 1 million adults worldwide will die within 30 days of non-cardiac surgery each year. 1,2 Perioperative risk estimation identi-fies patients who require more inten-sive monitoring and management in the postoperative period. Current preopera-tive risk prediction models for 30-day mortality have limitations. 4,5 Some cli-nicians advocate monitoring troponin measurements after vascular surgery, 6 and inconclusive evidence suggests that troponin measurements after abdomi-nal aortic surgery may enhance predic-tion of short-term mortality. 7 Little is known about optimal troponin thresh-old(s) for predicting mortality after non-cardiac surgery. A large international study called the VISION Study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation; clinicaltrials.gov identifier, NCT00512109) is evaluat-ing major complications after noncar-diac surgery. Participating patients have troponin T (TnT) levels measured after noncardiac surgery. We assessed the relationship between the peak fourth-generation TnT measurement after noncardiac surgery and 30-day mortality. METHODS Study Design and Eligibility Criteria The VISION Study is a prospective co-hort study of a representative sample of patients undergoing noncardiac sur-gery. VISION was designed to recruit 40 000 patients in North and South America, Africa, Asia, Australia, and Eu-rope to evaluate major complications after noncardiac surgery. At the begin-ning of this study, patients had fourth-generation TnT measurements after noncardiac surgery. The first 15 000 pa- Context Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days.