1) CHOOSE ONE. A 75-year-old man with a remote history of a myocardial infarction is referred to you after undergoing dobutamine echocardiography as part of a preoperative evaluation. The echocardiogram showed a baseline ejection fraction of 40% with evidence of scar in the anterior wall and ischemia in the inferior wall. He is scheduled to undergo carotid endarterectomy after evaluation for a recent transient ischemic attack. He denies any angina, dyspnea, proxysmal nocturnal dyspnea, orthopnea, or syncope, and has never undergone any kind of coronary revascularization. He does not have diabetes. He is being treated with aspirin 81 mg daily, long-acting metoprolol (Toprol-XL) 100 mg daily, ramipril (Altace) 10 mg daily, and simvastatin (Zocor) 20 mg daily. His resting heart rate is 56, his blood pressure is 133/72 mm Hg, and he has no evidence of heart failure or significant valvular heart disease. His electrocardiogram shows sinus rhythm and an old anterior wall myocardial infarction. His low-density lipoprotein cholesterol level is 105 mg/dL. To minimize his risk of a major perioperative event, you should:

1. Refer him for cardiac catheterization
2. Refer him for adenosine single-photon computed tomography (SPECT)
3. Allow him to undergo surgery, stressing the need to maintain his beta-blocking therapy
4. Allow him to undergo surgery, stressing the need to increase his simvastatin dose
5. Cancel surgery, since his dobutamine echocardiogram indicates his risk is prohibitively high