Figure 27-15 Assessment of cardiac risk in a patient about to undergo vascular surgery. If the clinical index is high, coronary arteriography (CATH) is recommended, with subsequent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for those with correctable lesions and patient (PT) consent. An equivocal history is followed by Holter monitoring and, if Holter monitoring is abnormal, by dobutamine stress echocardiography. CHF, congestive heart failure; ICU, intensive care unit; MI, myocardial infarction. (See the text and data of Fig. 27-9 for analyses by Mantha and colleagues.^[387] )