Risk stratification of patients with chest pain occurs daily by physicians in the primary care setting. When patients present in the office with recent or new-onset chest pain, the physician must determine the appropriate evaluation. Does this pain represent coronary artery disease or is the pain due to some other cause? When a patient with pre-existing risk factors for coronary artery disease presents with typical angina symptoms, the physician must recommend appropriate evaluation. Finally, how does one manage the patient in the emergency department with chest pain? All of these clinical situations presenting to the primary care physician require assessment through the performance of specific evaluations in the proper setting and time period. Some patients can be evaluated over hours or days. Other patients require immediate consultation with a cardiologist. This chapter first reviews the concept of risk stratification, definitions of coronary disease and looks at multiple stratification tools. Second, these tools are discussed as they are applied to stratifying patients with chest pain. The final section presents multiple case studies illustrating the use of these tools in the approach to the patient with chest pain.