Cardiovascular disease is a significant cause of morbidityand the leading cause of mortality in both the United Statesand worldwide.1,2 Given the considerable burden of disease,cardiac risk assessment is an especially important elementof preoperative evaluation prior to noncardiac generalsurgery.3 Globally, an estimated 100 million adults undergononcardiac surgery each year,4 more than one third of whomhave underlying coronary artery disease (CAD).5 Cardiaccomplications, including cardiac death, nonfatal myocardialinfarction (MI), and nonfatal cardiac arrest, represent majorcauses of peri- and postoperative morbidity and mortality.6The incidence of such cardiac complications is an estimated1.4% in relatively unselected patients,7 with an even greaterincidence (2.4 – 5.8%) among those with or at risk of cardiacdisease. 8,9,10,11,12,13 Annually, more than one million patientsare likely to experience such a complication.6 The magnitudeof this problem can be measured not only in patient healthoutcomes and illness burden, but also in terms of the large costsubsequently imposed upon the healthcare system, especially asthe number of noncardiac surgical patients at risk for adversecardiac outcomes continues to increase.