This review described the diagnostic efficacy of gated myocardial SPECT and its cost-effectiveness. Normal findings on myocardial stress SPECT predict negligible hard cardiac events. This prognostic value of myocardial SPECT influences cost-effectiveness of the strategy of the diagnosis of coronary artery disease. Despite the cost of the SPECT itself, the strategy of angiography following myocardial SPECT was the most cost-effective. Gated SPECT yields information regarding myocardial contractility and help differentiate attenuation artefact. Using gated SPECT, perfusion and contraction coupling can be interpreted. The test-retest reproducibility of global and regional contractile function of gated myocardial SPECT was excellent. Gated myocardial SPECT could be used to Predict functional improvement of myocardial dysfunction and to acknowledge improvement of myocardial function. Performance of rest-24 hour delay Tl-201 SPECT for viability study was good. Rest Tl-201/gated stress Tc-99m MIBI SPECT and 24-hour delay Tl-201 SPECT is a convenient method to diagnose coronary artery disease and myocardial viability.