Of the 570,000 patients who undergo vascular surgical procedures annually in the United States, 5% to 40% develop perioperative cardiac complications ( 1 Mantha S. Roizen M.F. Barnard J. et al. Relative effectiveness of four preoperative tests for predicting adverse cardiac outcomes after vascular surgery a meta-analysis. Anesthes Analges. 1994; 79: 422-433 Crossref PubMed Google Scholar , 2 Guidelines for perioperative cardiovascular evaluation for noncardiac surgeryReport of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on perioperative cardiovascular evaluation for noncardiac surgery). Circulation. 1996; 93: 1278-1317 PubMed Google Scholar , 3 Wong T. Detsky A.S. Preoperative cardiac risk assessment for patients having peripheral vascular surgery. Ann Intern Med. 1992; 116: 743-753 Crossref PubMed Scopus (95) Google Scholar , 4 Gibbons R.J. Zinsmeister A.R. Miller T.D. Clements I.P. Supine exercise electrocardiography compared with exercise radionuclide angiography in noninvasive identification of severe coronary artery disease. Ann Intern Med. 1990; 112: 743-749 Crossref PubMed Scopus (32) Google Scholar ). Although preoperative exercise testing can predict intraoperative cardiovascular events, the association between preoperative testing and long-term outcomes is less clear. We sought to determine the value of preoperative exercise testing with a supine bicycle in predicting perioperative cardiovascular events and long-term outcomes in patients scheduled for vascular surgery.