Although the use of nuclear myocardial imaging is not yet widespread in China, it is already the most commonly used technique for the diagnosis and management of coronary artery disease in Western developed countries. What are the clinical advantages of nuclear myocardial imaging and what shortcomings does it make up for other tests? The diagnostic effect is fully affirmed. Nuclear myocardial imaging has a very important role and status in the diagnosis and management of modern coronary heart disease. In the past decade, the annual number of clinical examinations of stress nuclear myocardiography in the United States has far exceeded that of electrocardiography, coronary angiography and stress echocardiography, becoming the most commonly used technique for the diagnosis and management of coronary artery disease. The application of nuclear myocardial imaging in the diagnosis, risk stratification, and prognosis of coronary artery disease has been fully recognized and recommended in the guidelines of the American College of Cardiology. Gated nuclear myocardial imaging, which has been developed and matured in recent years, can obtain both myocardial perfusion parameters and left ventricular function parameters during a single image acquisition. Without increasing the cost of the examination, gated nuclear myocardial imaging further improves the sensitivity, specificity and accuracy of the diagnosis of coronary artery disease, and also significantly increases the value of the prognosis and risk stratification of coronary artery disease. Several clinical studies have demonstrated that the value of nuclear myocardial imaging in prognosis and risk stratification of coronary artery disease is significantly superior to clinical and electrocardiographic exercise tests, as well as to coronary angiography. Accurate prognosis and risk stratification of coronary artery disease is the key to modern diagnosis and management of coronary artery disease. Patients with suspected or confirmed coronary artery disease can be accurately classified into low-risk, intermediate-risk and high-risk patients based on nuclide myocardial imaging. Today, it is possible to develop specific management plans for patients with coronary artery disease based on semi-quantitative and quantitative myocardial images: patients with mild abnormalities in myocardial images are suitable candidates for drug therapy; patients with moderate abnormalities in myocardial images are suitable candidates for drug therapy if not required by special occupations and if the patient has a strong desire; only patients with severe abnormalities in myocardial images are suitable candidates for invasive investigations, treatments and coronary artery bypass grafting. Only patients with severe abnormalities in nuclear myocardial imaging are suitable candidates for invasive testing, treatment and coronary artery bypass grafting. Coronary angiography can reflect the degree of coronary stenosis more visually and accurately, and it is still the accepted “gold standard” in the diagnosis of coronary artery disease. However, coronary angiography only reflects the two-dimensional morphological changes of the larger vessels on the surface of the heart above the millimeter level, and the impact of this morphological change on myocardial perfusion and on the reserve capacity of the coronary arteries cannot be directly answered by coronary angiography itself. From the definition of coronary artery disease, the essence is the presence or absence of symptoms and objective evidence of “myocardial ischemia”. Nuclear myocardial imaging is a reflection of myocardial perfusion. This is the theoretical and technical basis for its better prognostic and risk stratification value. On the other hand, there are limits to how well coronary angiography, a two-dimensional imaging morphology, can reflect the degree of coronary stenosis. In some cases, it cannot accurately determine the degree of fixed coronary stenosis, such as lesions at the bifurcation, open lesions, and eccentric stenosis. Also, coronary angiography is somewhat limited in determining the degree of fixed stenosis in unstable lesions, as well as in vessels associated with myocardial infarction. Because these lesions, in addition to fixed stenosis, kinetic changes in coronary arteries, abnormalities in endothelial function, plaque breakdown and thrombus formation play an important or even decisive role in the occurrence and development of myocardial ischemia. One of the fastest growing clinical applications of nuclide myocardial imaging in recent years is the diagnostic management of patients with acute coronary syndromes. The use of nuclear myocardial imaging as the only important diagnostic tool for coronary artery disease in clinical practice may result in missed diagnoses and delayed treatment. Only the comprehensive and rational application of invasive and non-invasive tests such as ECG exercise test, nuclear myocardial imaging, stress ultrasound and coronary angiography can improve the clinical diagnosis and treatment of coronary artery disease and standardize the clinical application of coronary artery disease diagnostic and management techniques.