Background: High risk patients who undergo a non-cardiac surgery often develop a perioperative myocardial infarction (PMI). Objective: To study the incidence of PMI among high risk patients who undergo preoperative evaluation for non-cardiac surgery by cardiologists. Material and Method: This study was a cross-sectional study, performed at Thammasat Hospital for one year. Eligible patients were subjects older than 40 years with pre-existing cardiovascular disease or with at least one major cardiovascular risk factor including chronic kidney disease who underwent non-cardiac surgery with preoperative cardiovascular evaluation. The primary outcome is perioperative myocardial infarction. Results: Fifty-three patients (mean age 70.5 years, 54.7% female) were eligible for the study. Most of these patients underwent orthopedic surgery (24 patients, 45.3%) and general surgery (18 patients, 34%). Four female patients developed PMI, representing the incidence of 7.5 percent. Chronic kidney disease and peripheral arterial disease were statistically significant associated with PMI. Conclusion: The incidence of PMI in this study was slightly higher than those reported in previous studies. Therefore, physicians should be aware of the diagnosis and proper management of this condition.