Zavitz CCJ, et al. - Current preoperative cardiac risk stratification practice at a tertiary vascular center was determined. In addition, evaluation of these schemes was done in real-world practice, and an optimized approach was proposed. From the Vascular Quality Initiative database, researchers included data of 178 open surgical abdominal aortic aneurysm repairs, including 129 elective cases, for this retrospective analysis. Preoperative cardiac stress testing was performed on the majority of elective patients (62%). Of these stress tests, 79% were negative, yet an adverse cardiac event occurred in 33% of these patients (vs 48% of those with positive stress tests). Observations suggest only the modestly protective value of stress testing for preoperative cardiac risk stratification against adverse cardiac events undergoing open abdominal aortic aneurysm repair.