Perioperative myocardial infarction (PMI) is associated with a high mortality rate. Detection of PMI, however, is difficult due to a lack of typical anginal symptoms associated with the use of strong analgesics. Also, characteristic changes on the electrocardiogram may be minimal and/or transient. Recent studies have shown that postoperative troponin elevation is a strong, independent predictor of short- and intermediate-term mortality. In this article, we illustrate the importance of routine troponin measurements after major non-cardiac surgery with two patient cases. Moreover, we provide a brief overview of current evidence on perioperative myocardial infarction, and highlight current and future perspectives of troponin measurements.