15,133 patients (45 years or older) undergoing non-cardiac surgery were included in this study (the VISION fourth-generation TnT prognostic study). The purpose of this large, international prospective cohort study was to determine whether peak postoperative troponin-T (TnT) values are associated with 30-day mortality rates. Results indicated that peak postoperative TnT values were the strongest predictors for 30-day mortality rates in this patient population. The median time from the peak TnT measurement to death became shorter with increasing peak TnT values. The net re-classification improvement (for risk categories) associated with assessing postoperative TnT values was 25.0%, compared to the assessment of preoperative risk factors only. According to the population attributable risk analysis, high TnT values in the postoperative period may explain 41.8% of deaths.