Although referral to revascularization may be conditional on the results of coronary angiography, our study shows that when SPECT results are available, they exerted significant impact on the decision to revascularize. This suggests that physicians have appropriately incorporated the SPECT and angiographic results in patient management. A previous study has shown that patientS with reversible ischemia, multivessel or large perfusion abnormalities, transient left ventricular dilation during stress, and increased lung-to-heart ratio have a high rate of cardiac events with medical therapy, and these patients may benefit from coronary revascularization. Thus, patients with CAD who undergo early revascularization are more likely to have extensive anatomic and functional evidence of CAD, whereas patients who are treated medically appear to be at lower risk. The use of early revascularization appears to be appropriate in most patients and this selection is enhanced by the use of SPECT imaging.