In summary, nearly 25% of all inappropriate stress imaging studies are performed in asymptomatic patients who have undergone revascularization <2 years after PCI (6). The study by Shah et al. (7), despite its limitations as a retrospective analysis of insurance claims, highlights the high and probably excessive use of stress testing in the first year after revascularization, with marked regional variation in test use. This study serves as another wake-up call to cardiovascular specialists to be more diligent in adhering to evidence-based practice guidelines and AUC. The value of stress imaging is greatest in the evaluation of risk for future cardiac events in symptomatic patients to identify those who would benefit the most from revascularization strategies. Our goal as cardiovascular specialists is to educate patients and referral physicians regarding the appropriate indications for expensive stress imaging procedures and where diagnostic and prognostic value is greatest. If we fail in this duty, we will be coerced into constantly securing pre-authorization from payers for diagnostic imaging tests to be performed for our patients. The problems with pre-authorization for formal approval of use of testing have been well described (11). They include no evidence for improved quality of care, the favoring of indiscriminate volume reduction, the lack of transparency, the fact that such measures are not based on AUC, inconsistent processes often characterized by confusion and inefficiency, reduced timeliness, an unstated goal of steerage to the test of least resistance, labor intensiveness, and scant data available for feedback or education (11). Thus, it behooves cardiovascular specialists to advocate for and adhere to accepted AUC developed by our own scientific societies.