Invasive coronary angiography (ICA) is considered the gold standard for determining the percent of stenosis due to plaque in a coronary artery. However, the degree of stenosis on ICA is not always an accurate predictor of heart attack risk because it gives no information on perfusion. Cardiac hybrid imaging combining coronary CT angiography (CCTA) and SPECT myocardial perfusion imaging (MPI) has shown promise to address this issue but so far studies have been limited to short-term observations. This article summarizes the result of a recent study of the long-term prognostic value of hybrid CCTA – SPECT MPI.