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However, as CAD advances, several factors can complicate the interpretation of MPI, subsequently impacting clinical decision\u2010making. This review focuses on the utility of MPI by means of cardiac magnetic resonance (CMR) imaging, single\u2010photon emission computed tomography (SPECT) and positron emission tomography (PET) in patients with advanced CAD\u2014the latter characterized by documented CAD (i.e. prior myocardial infarction [MI] and\/or percutaneous coronary intervention [PCI]), prior coronary artery bypass grafting (CABG) or the presence of a chronic total occlusion (CTO). It will discuss factors impacting the interpretation of MPI, the diagnostic performance for detecting obstructive CAD and coronary microvascular dysfunction (CMD), as well as the role of MPI in guiding revascularization.<\/jats:p>","DOI":"10.1111\/eci.70024","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T07:00:59Z","timestamp":1742281259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Myocardial perfusion imaging in advanced coronary artery disease"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7927-0366","authenticated-orcid":false,"given":"Roel","family":"Hoek","sequence":"first","affiliation":[{"name":"Department of Cardiology Amsterdam University Medical Center, Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pepijn A.","family":"van Diemen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam University Medical Center, Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvemarie B. 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