Recent findings from Gutierrez del Arroyo and colleagues identified distinct sub-phenotypes in patients undergoing major noncardiac surgery based on biomarkers such as N terminal pro-brain natriuretic peptide, renin, aldosterone, and angiotensin-converting enzyme 2, which were associated with varying risks of postoperative myocardial injury. Although their findings highlight the potential of sub-phenotyping for advancing perioperative precision medicine, further research is needed to validate these sub-phenotypes and explore their role in tailoring perioperative management strategies.