Pharmacological stress testing with Tc-99m sestamibi is being used extensively for the diagnosis of coronary disease. Although there are no randomized and prospective studies using this technique for preoperative evaluation of patients undergoing noncardiac surgery, there are several studies that indicate that it is equivalent to exercise perfusion imaging and can be used for evaluating the prognosis of patients with coronary artery disease (CAD). This review will discuss these studies.