Myocardial perfusion imaging (MPI) using nuclear techniques is a well-established diagnostic tool in the management of patients after acute coronary syndromes (ACS) or acute myocardial infarction (AMI) providing non-invasively information about perfusion and function. Single photon emission computed tomography (SPECT) is routinely applied for MPI allowing the characterization of localization, extent and severity of perfusion abnormalities. During recent years gated SPECT MPI has emerged to a technique that can accurately define individual patient risk among clinically stable survivors of AMI by the assessment of total left ventricular (LV) perfusion defect size, the extent of inducible ischaemia, and the degree of LV dysfunction. The documented prognostic value of these scintigraphic parameters is of clinical importance to guide decisionmaking in the cardiac patient. Moreover, the cost-effectiveness of implemented MPI in the work-up of patients after AMI has been demonstrated.