Perioperative revascularization does not benefit patients with stable CAD for 2 reasons. First, our “gold standard” for detecting coronary disease and determining its severity may not be as accurate as we once thought. As studies with intravascular ultrasonography, magnetic resonance–enhanced imaging, and coronary fractional flow emerge, we recognize that coronary arteries may be diffusely diseased yet appear remarkably normal on angiographic imaging (16). Coronary disease is far more complex than the number of diseased vessels, plaque burden, or morphologic characteristics: It is the biology rather than the anatomy of coronary arteries that matters most. Coronary revascularization may not reduce the risk for coronary thrombosis, vasospasm, or plaque rupture, and these mechanisms are central to the precipitation of perioperative cardiac events.