On the basis of the above considerations, preoperative risk stratification can be simplified so that the following questions are addressed (Figure). First, has the patient had coronary revascularization within 5 years without recurrent symptoms? If “yes,” the patient may have surgery, since risk for perioperative myocardial infarction or death is very low. Second, would cardiac catheterization and revascularization be chosen irrespective of the proposed noncardiac surgery? If “yes,” the urgency of the noncardiac surgery must be weighed against the urgency of coronary angiography and revascularization. If the surgery is elective and the need for revascularization is pressing, angiography or revascularization should be done and noncardiac surgery should be deferred. If “no,” and the patient has none of the revised cardiac risk index variables, noncardiac surgery can be done without delay. If the patient has one or two risk variables, β-blockade should be initiated perioperatively. If β-blockade is contraindicated, surgery can be done without it, since the risk in these patients is only minimally increased. If the patient has three or more risk variables, β-blockade should be initiated perioperatively. If β-blockade is contraindicated or the surgical risk is deemed excessive, canceling or deferring the surgery should be considered. In such patients, DSE may be helpful since perioperative risk is low in patients without ischemia and high in patients with ischemia (43).