This is a prospective study in patients who undergo routine postoperative troponin assessment after major (semi-)elective noncardiac surgery. Two groups are created based on postoperative troponin levels: Postoperative myocardial injury (PMI) group with troponin I levels ≥ 60 ng/L and a control group with troponin levels < 60ng/L. The primary aim of this study is to assess the association of PMI with pulmonary embolism. Additionally, the association between PMI and obstructive CAD will be investigated.

Inclusion Criteria:

• ≥ 60 years old
• Major noncardiac surgery, defined as non-cardiac surgical procedures requiring hospital admittance > 24 hours
• Semi-elective surgery, defined as surgery that that has been preceded by a preoperative evaluation.
• ≥ 1 troponin assessment in the first 3 postoperative days as a part of the routine 'postoperative troponin assessment' protocol.
• For patients who undergo surgery more than once, the first surgery will be included in the analysis. Reoperations will not be included.

Exclusion Criteria:

• Typical anginal complaints
• Acute ST-elevation myocardial infarction (STEMI) or new left bundle branch block (LBBB) on ECG
• Patients unable to fully comply to study needs (e.g. incompetent patients or patients unable to communicate in Dutch or English)
• Severe claustrophobia.
• Patients who have a life expectancy of less than three months.
• Patients who are too ill to undergo a CCTA or Ventilation/Perfusion (V/Q) scan.

Patients of 60 years or older that undergo major (semi-)elective noncardiac surgery are eligible for study participation. Major (semi)-elective noncardiac surgery is defined as all surgical procedures requiring ≥ 24 hours of hospital admittance that have been preceded by a preoperative evaluation.