CABG might be associated with lower risk of mortality in patients with diabetes mellitus and multivessel disease than PCI, but this remains uncertain. The ongoing FREEDOM (Future Revas- cularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial could help resolve this question.1177 Obese individuals frequently have reduced physical work capacity and exaggerated dyspnea on exertion. Furthermore, weight limits of exercise and imaging equipment preclude testing the very obese.1178,1179 Because of limitations in exercise testing and challenges with imaging through in- creased breast tissue or chest girth, reduced diagnostic accu- racy has been reported for obese patients.1180 Because of breast tissue artifact, myocardial perfusion PET is more accurate than myocardial perfusion SPECT for the obese patient,191,193,323 although attenuation-correction algorithms or prone imaging can help improve myocardial perfusion SPECT accuracy.187,188 Intravenous contrast enhancement improves image quality in obese patients and results in improved diagnostic certainty for stress echocardiography.181 5.12.5. Chronic Kidney Disease CKD confers greater risk for developing SIHD, for its progression, and for poor outcomes after interventions for AMI.1181 1183 The mortality rate for patients on hemodialysis is .20% per year, and approximately 50% of deaths among these patients are due to a cardiovascular cause.27,1184 To avoid worsening underlying kidney disease, physicians should consider creatinine clearance in pharmacotherapy and should apply risk scores for predicting the likelihood of contrast-induced nephropathy1161,1185 in conjunction with the use of renal protective strategies such as isosmolar contrast agents during angiography.3,4,4a Unfortunately, studies evaluating the outcomes of revascu- larization in patients with renal disease have not applied a consistent definition of renal disease. Only one study identi- fied by the writing committee used the Kidney Disease Outcome Quality Definition of renal disease grades: Stage 1, mL/min; and Stage 5, ,15 mL/min or ongoing dialysis (1186). 