To delineate the role of routine preoperative coronary angiography in patients undergoing elective abdominal aortic aneurysm resection, we reviewed the records of 422 such patients at the Mayo Clinic, Rochester, Minn. One hundred seventy-three patients (41%) had a history of either myocardial infarction or angina pectoris; 146 (35%) had a previous myocardial infarction; 111 (26%) had a history of stable angina. Six patients underwent coronary artery bypass grafting prior to aneurysmorrhaphy. Ten patients (2.4%) died within the first 30 postoperative days. Seven deaths (1.7%) were secondary to myocardial infarction. Mortality from myocardial infarction was 0.8% in patients who had no history of coronary artery disease and 2.9% in patients with a history. Mortality was not increased in elderly patients. Coronary angiography should be selectively obtained prior to elective aneurysmorrhaphy. A 0.8% mortality from myocardial infarction in patients without a history of coronary artery disease and an overall mortality of 1.7% do not justify routine coronary angiography prior to elective resection of an abdominal aortic aneurysm.