Routine prophylactic coronary revascularization should not be performed in patients with stable CAD before noncardiac surgery.449,450 (Level of Evidence: B) 2. Elective noncardiac surgery should not be per- formed in the 4 to 6 weeks after balloon angio- plasty or BMS implantation or the 12 months after DES implantation in patients in whom the P2Y12 inhibitor will need to be discontinued periopera- tively.208,447, 451,452 (Level of Evidence: B) The 2007 and 2009 ACC/AHA Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery gave detailed recommendations for the evaluation of patients undergoing noncardiac surgery.444 Patients with evidence of ACS should receive standard therapy, including early revas- cularization, to minimize the risk of adverse events. Patients with known significant left main or 3-vessel CAD who would otherwise benefit from revascularization in terms of survival or symptomatic relief also generally undergo revasculariza- tion before elective noncardiac surgery. Two RCTs449,450 found no benefit with routine preopera- tive revascularization before noncardiac surgery. Noncardiac surgery early after coronary stenting, particularly in the first 4 weeks, is associated with a high risk of stent thrombosis and death.444,446,448 When emergency surgery is necessary, the patient should proceed to surgery without prior PCI. When surgery is required within 30 days and coronary revascular- ization is required before surgery, many clinicians perform balloon angioplasty alone to avoid the need for DAPT. In situations where preoperative revascularization is required and surgery can be deferred for at least 30 days, many clinicians use BMS and discontinue DAPT after 30 days. If surgery is elective and can be deferred for 1 year, most clinicians would consider DES to reduce the long-term risk of restenosis. A dilemma occurs when a patient has undergone PCI and then unexpectedly requires noncardiac surgery. 