Aims: The main objective of the present analysis was to determine the usefulness of a preoperative 12-lead ECG for evaluating the risk of perioperative morbidity and mortality. Methods:We performed a secondary analysis of the “NoRisk”Study. Inclusion criteria were age >55 years and at least one cardiovascular risk factor. The combined primary endpoint included total mortality, acute myocardial infarction, cardiopulmonary resuscitation, heart failure, and asystole or ventricular fibrillation during hospitalization. ECGs from 616 patients were analyzed. Results: Fourteen (2.3%) patients suffered from the combined primary endpoint while in the hospital. In Kaplan-Meier analyses, a pathologic Q wave and QTc>500ms were significantly related to the incidence of the primary endpoint (p<0.001, p=0.042, respectively). Conclusion: The 12- lead ECG is still an important diagnostic tool for perioperative risk assessment of cardiovascular events in noncardiac surgery in patients at risk.