For this patient with known coronary artery disease (CAD) but normal cardiac function scheduled for intermediate-risk surgery (defined as a risk of cardiac death or nonfatal myocardial infarction of 1%-5%), electrocardiography is indicated according to the current American College of Cardiology/American Heart Association (ACC/AHA) guideline. Due to the patient's CAD, the baseline electrocardiogram may be abnormal but probably would not alter preoperative management. Instead, the electrocardiogram guides postoperative medication management by identifying conduction disturbances (such as QT-interval prolongation) and is useful as a comparison should the patient develop postoperative cardiac symptoms.

The ACC/AHA guideline does not support noninvasive coronary evaluation (either pharmacologic or exercise stress testing) in this patient. Regardless of cardiac risk factors, no further coronary evaluation is advised for patients with an exercise capacity greater than or equal to 4 metabolic equivalents (METs), and climbing a flight of stairs meets that criterion. In patients with an exercise capacity less than 4 METs, coronary evaluation is indicated if the estimated risk of perioperative major adverse cardiac events is greater than or equal to 1%. Due to its superior prognostic value, exercise testing is preferred to pharmacologic stress testing unless contraindicated by patient factors.

A resting echocardiogram only provides diagnostic information about structural heart disease and is not an appropriate form of noninvasive coronary evaluation. Therefore, preoperative echocardiography is not indicated in this patient without evidence of significant structural heart disease.