Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac imaging is a leading method in the diagnosis and treatment of ischemic heart disease. As the prognostic value of exercise stress tests for women is relatively low, ESC Guidelines suggest more accurate imaging method. Myocardial perfusion imaging with SPECT is one of the most commonly performed non-invasive cardiac imaging tests evaluating myocardial viability, assessing prognosis and estimating the efficacy of therapy. Purpose To determine the role for cardiac nuclear imaging for women with suspected coronary artery disease (CAD) in Latvia and to analyze prescribed further diagnostic approaches to establish the diagnosis and appropriate treatment. Methods For women included in Latvian cardiac SPECT registry the cardiac SPECT was performed in single University Hospital from 2018 till 2021. The patients were divided into 2 groups: normal myocardial perfusion and true myocardial perfusion defect, defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed further diagnostic test or treatment option. Results 700 women with suspected CAD were analyzed. True myocardial perfusion defect was detected in 120 patients (17.1%). As further diagnostic approach in 29 (24.2%) cases cardiac computed tomography angiography (CTA) was performed; the invasive coronary angiography (ICA) - in 76 (63.3%) cases and percutaneous coronary intervention (PCI) in 15 (12.5%) cases was suggested. Analyzing results of all performed CTAs’, stenosis in main coronary arteries were not found (100%) and CAD was excluded. Of all performed ICA, in 41 (53.9%) women atherosclerosis in main coronary arteries was not observed and microvascular angina as a primary diagnosis was assessed. In 17 (22.3%) patients the significant stenosis in main coronary arteries was present and PCI was performed, of whom 10 (58.5%) women were primarily diagnosed. 1 patient (1.3%) underwent coronary artery bypass surgery (CBP). In 9 (11.8%) patients significant stenosis was not detected and they were discharged on optimal medical treatment (OMT). In all these 9 patients the CAD was already known before the SPECT. From all suggested PCIs’: 8 women underwent PCI (53.3 %), 1 – CBP (6.6%) and 6 (40%) patients continued OMT. Conclusion Based on Latvian cardiac SPECT registry data, myocardial perfusion imaging with cardiac SPECT is valuable and is highly recommended for the diagnostics of women with known or suspected CAD. Despite the low availability of cardiac SPECT in Latvia, the registry shows the importance of nuclear diagnostics for such a difficult to diagnose group as women.