Patients who develop NSTE-ACS following noncar- diac surgery should receive GDMT as recommended for patients in the general population but with the modifications imposed by the specific noncardiac surgical procedure and the severity of the NSTE- (Level of Evidence: C) 2. In patients who develop NSTE-ACS after noncardiac surgery, management should be directed at the un- (Level of Evidence: C) Patients with NSTE-ACS following noncardiac surgery should be managed according to the guidelines for patients in the gen- eral population, with risk stratification and guideline-based phar- macological and invasive management directed at the etiology (eg, hypertension, tachycardia, HF, hypotension, sepsis, and ane- mia) with modifications based on the severity of NSTE-ACS and the limitations imposed by the noncardiac surgical procedure. The definition of ACS has a substantial effect on reported Some patients may not be able to give a history of ischemic symptoms because of the noncardiac sur- gery. The criteria in the 2012 Third Universal Definition of MI should be applied.21 In patients at risk of ACS following non- cardiac surgery, routine monitoring of troponins and ECGs may be performed. As the sensitivity of troponin assays improves, the frequency of identifying perioperative MI will increase. In the POISE (Perioperative Ischemic Study Evaluation) trial,645 of 8351 patients randomized to extended-release metoprolol versus placebo, 5.7% of patients in the control group had a perioperative MI typically occurring within 48 hours and often not associated with ischemic symptoms. ACS in the setting of noncardiac surgery is associated with increased mortality. 