A Clinical Randomized Trial to Evaluate the Safety of a Noninvasive Approach in High-Risk Patients Undergoing Major Vascular Surgery: DECREASE-V Pilot Study Don Poldermans, Olaf Schouten, Radosav Vidakovic, Jeroen J. Bax, Ian R. Thomson, Sanne E. Hoeks, Harm H. H. Feringa, Martin Dunkelgrün, Peter de Jaegere, Alexander Maat, Marc R. H. M. van Sambeek, Miklos D. Kertai, Eric Boersma, for the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo Study Group A total of 101 vascular surgery patients with extensive stress-induced ischemia were randomly assigned to prophylactic coronary revascularization (n = 49) or no revascularization. Revascularization did not improve 30-day outcome; the incidence of all-cause death or nonfatal myocardial infarction was 43% versus 33% (odds ratio 1.4, 95% confidence interval 0.7 to 2.8; p = 0.30). Also, no benefit during 1-year follow-up was observed after coronary revascularization (49% vs. 44%, odds ratio 1.2, 95% confidence interval 0.7 to 2.3; p = 0.48). In conclusion, preoperative prophylactic coronary revascularization in vascular surgery patients with extensive stress-induced ischemia is not associated with an improved 30-day and long-term outcome.