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Nuclear cardiology is useful for risk stratification of major cardiac events (MCEs) in Japanese patients with coronary artery disease (CAD). Results of the J-ACCESS study demonstrated that the severity of the summed stress score (SSS) stratifies the risk of future MCEs. A normal SSS predicts a good prognosis and a higher SSS indicates a higher MCE risk. Investigating the association between therapeutic strategy and the risk of MCEs, we demonstrated that revascularization reduces the risk of MCEs in patients with >10% ischemia while optimal medical therapy achieves the same outcome in patients with ≤5% ischemia. We also formulated a risk equation on the basis of evidence obtained from nuclear cardiology to predict the risk of MCEs excluding severe heart failure. In order to benefit from such evidence, it is necessary that expert interpreters precisely evaluate ischemia based on images derived during nuclear cardiology studies. However, automated quantification with total perfusion deficit does not require expert interpreters. We have reported the usefulness of automated quantification with the total perfusion deficit derived from a Japanese normal database in Japanese patients with CAD. Ischemic data obtained from nuclear cardiology are extremely useful for predicting MCEs in patients with CAD. A therapeutic strategy guided by the ischemic data facilitates good medical management with an associated improved prognosis.

Clinical Value of Ischemia Evaluation with Nuclear Cardiology to Predict a Risk of Cardiovascular Events