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To the editor:In a retrospective observational clinical study including 482 elderly patients with coronary heart disease undergoing elective major noncardiac surgery,Liu et al1 showed that the incidence of perioperative major adverse cardiac events (MACEs)was 12.7％,and five risk factors were independently associated with perioperative MACEs.This study makes an important contribution to the effort to define risk factors for perioperative MACEs in elderly patients with coronary heart disease undergoing noncardiac surgery.Strengths of this study include a large sample of patients and most of the known risk factors that can affect perioperative MACEs.Furthermore,the authors have used appropriate methods to identify independent risk factors for perioperative MACEs.However,in our view,there are several aspects of this study that should be considered.