Cardiovascular complications are important causes of morbidity with major non cardiac procedures. Preoperative risk stratification relies on the identification of the cardiac problem, its stability, its severity and previous treatment. The approach to risk stratifying preoperative patients should be performed by accepted guidelines used for patients with suspected coronary artery disease (CAD) or known CAD and not as an "obligatory test" prior to operation. Risk stratification is based on clinical predictors, stress testing, including cardiac imaging if necessary, and the kind of operation. Most of the tests are noninvasive and some invasive tests conducted are intended to identify myocardial ischemia and critical lesions of the coronary arteries. Most of the patients are able to undergo elective procedures without any problem with the perioperative cardiac event rate of up to 2% considered as an accepted goal. The use of invasive diagnostic and therapeutic methods, such as cardiac catheterization, PCI, CABG, has to be restricted only to patients who are at very high risk. The partial reduction of the cardiac event rate in the short term and monitoring for 24 hours after operation is most important, as well as the administration of beta blockers, starting prior to surgery. Furthermore, long term follow-up for cardiac events in these patients in essential, as the clinical predictors and cardiac tests performed for preoperative risk stratification are also used for long term prognosis.