Aim: To determine the incidence and risk factors for acute myocardial injury after non-cardiac surgery at Aga Khan University Hospital Nairobi. Design: Prospective cohort study Background: Myocardial injury is the most common major cardiovascular complication in patients undergoing non-cardiac surgery. Large numbers of intermediate-risk and high-risk cardiac patients will be undergoing surgery as the population grows older, and thus myocardial injury after non-cardiac surgery could be a rising problem. Patients and Setting: Adult participants undergoing intermediate and high risk non-cardiac surgery at the Aga Khan University Hospital Nairobi were evaluated for incidence and risk factors for myocardial injury after non-cardiac surgery. Methodology: The study was conducted over 5 months and recruited eligible participants who were scheduled to undergo intermediate and high risk non-cardiac surgery. Their age, gender, height, weight, blood pressure, random blood sugar, haemoglobin, creatinine were assessed preoperatively and later on, an electrocardiogram as well as highly sensitive cardiac troponin T were measured 24 hours postoperatively. Results: 128 participants were evaluated for the incidence and risk factors for myocardial injury after non-cardiac surgery in this study. Of these, 87.5% underwent intermediate surgery. None of the participants developed ischemic chest pain. 21% had electrocardiographic changes; 12% had T-wave inversion, 9% had ST-depression and none had ST-elevation or new left bundle branch block. 25% of the participants had elevated troponin (>14ng/ml) but only 12.5% had a significantly elevated troponin (>50ng/ml). The odds ratio for hypertension, diabetes, elevated random blood sugar were 19.9(95% confidence interval, 1.1-340.2), 11.5(95% confidence interval, 3.6-37.1) and 2.6(95% confidence interval, 1.8- 3.9) respectively. Conclusion: The incidence of acute myocardial injury after high and intermediate risk non-cardiac surgery at the Aga Khan University Nairobi is 12.5%. Hypertension, diabetes and elevated random blood sugar significantly increase the risk of developing acute myocardial injury after high and intermediate risk non-cardiac surgery.