Objective To determine the value of preoperative electrocardiogram (ECG) in the prediction of postoperative cardiovascular complications in elderly patients undergoing schedualed non-cardiac surgery. Methods A retrospective cohort study was carried out on the patients aged 60 years or older undergoing elective non-cardiac surgery in our department from November 15,2 to January 15,3. The results of preoperative ECG, perioperative data and postoperative complications during the hospital stay were recorded and analyzed. Results There were 784 patients included in the final analysis, and 275 of them (35.1%) were found having cardiac abnormality according to the results of ECG. There was no difference in the incidence of postoperative cardiovascular complications between those patients with and without normal ECG preoperatively (3.7% vs 3.6%, P=0.946). The area under ROC curve for postoperative cardiovascular complications predicted by abnormal preoperative ECG was 0.547 (95%CI:0.447-0.581, P=0.351). Multivariate logistic regression analysis showed that female gender (OR=3.164,5%CI:1.365-7.335, P=0.007), older age (OR=1.131, 95%CI:1.068-1.198, P<0.001), higher grade of American Society of Anesthesiologists Classification (OR=3.067, 95%CI:1.394-6.750,P=0.005) and prolonged duration of surgery (OR=1.284,5%CI:1.045-1.489, P=0.014) were independent predictors of postoperative cardiovascular complications. Conclusion Preoperative ECG is of limited value in the prediction of postoperative cardiovascular complications in the elderly patients undergoing schedualed non-cardiac surgery.