Recent technological advances provided clinicians with multiple options for diagnosing and prognosticating patients with coronary artery disease (CAD). Myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography is a powerful tool for assessing physiologically significant coronary atherosclerosis, but is unable to detect subclinical atherosclerosis. Coronary computed tomographic angiography permits rapid noninvasive assessment of the coronaries and demonstrates an impressive negative predictive value in the clinical literature. Nevertheless, the positive predictive value of computed tomographic angiography for clinically significant CAD is suboptimal. The combination of both of these techniques provides an opportunity to the clinician to assess for subclinical atherosclerosis (with important implications for therapy in low-intermediate risk patients) and functionally significant lesions in patients with extensive CAD. However, the application of this technology has to be implemented on a case-by-case basis to avoid unnecessary radiation exposure and cost.