Cardiovascular disease is the major cause of postoperative morbidity and mortality. In Europe, 40.000.000 surgical procedures are performed every year, with a cardiovascular mortality rate of 0.3% (133.000 patients). To improve postoperative outcome, preoperative identification of patients at risk is performed using clinical risk scores, biomarkers for coronary artery disease and heart failure, and cardiac imaging. The preoperative risk assessment is linked to the intraoperative identification of acute coronary syndromes using electrocardiography and cardiac imaging as well as newly identified biomarkers. The follow-up of these patients is performed regularly, for early identification of cardiac events. The identification of a genetic predisposition in relation with biomarkers and subsequent treatment is the research line of this group.