The aim of perioperative risk evaluation before non-cardiac surgical procedures is to prevent cardiac complications and thus improve the prognosis of patients. In the following chapter, we refer, among other things, to the new ESC guideline for cardiovascular risk evaluation and management of patients before a non-cardiac operation from 2022. We provide an overview of action instructions and algorithms for a structured patient assessment, especially for patients with new heart sounds, shortness of breath, edema, or angina pectoris. In addition, there is a new focus on the assessment of frailty and on informed consent in the context of patient and relative education. Diagnostically, biomarkers (BNP and troponin) play a role, and therapeutically, the management of anticoagulant medication, bleeding, and perioperative cardiovascular complications play a prominent role. For the first time, specific attention is paid to the care of patients with malignant underlying diseases and with COVID-19 diseases.