Positron emission tomography (PET) expands the diagnostic possibilities of nuclear medicine techniques for the diagnosis of coronary artery disease and, especially, for the identification of myocardial viability. The presence of coronary artery disease can be detected by evaluation of myocardial blood flow at rest and during pharmacologically induced hyperemia with a sensitivity of 84 to 98% and a specificity of 78 to 100% according to recent studies. Comparative investigations in the same patients have demonstrated a significant gain in the diagnostic accuracy of PET as compared with single photon emission computed tomography (SPECT). PET has influenced even more profoundly the identification of myocardial viability. Measured against the functional outcome of regional contractile function after successful revascularization, an increase of glucose utilization relative to regional myocardial blood flow is 77 to 85% accurate in identifying reversibly injured myocardium. Conversely, PET is 78 to 92% accurate in identifying myocardium as irreversibly injured when pre-operative glucose uptake was reduced or absent. Recent studies have indicated that it is possible to predict to some extent post-revascularization improvement in left ventricular function as well as in congestive heart failure related symptoms in patients with ischemic cardiomyopathy. Furthermore, PET can identify patients with an increased risk of mortality and morbidity as a result of ischemic heart disease and, thus, stratify patients to the most appropriate and cost-effective therapeutic approach.