Coronary artery disease (CAD) still remains one of the leading causes of mortality in many countries with more than 17 million deaths worldwide. This study aimed to assess the predictors of myocardial viability in patient with coronary artery chronic total occlusion (CTO) by Myocardial Perfusion Imaging. Methods: This study included 100 patients with previous coronary angiography (CA) in which they detected that they have one or more vessel with CTO. And patients were divided in to two groups: Group 1: Viable Myocardium, and Group 2:  Non-Viable Myocardium. Patients were subjected to complete history taking, general and local physical Examination, 12 Lead ECG, Laboratory investigation of serum troponin, conventional Echocardiography, Diagnostic Coronary angiography, and Single photon emission computed tomography (SPECT). This study included 100 male with no females included. Their mean age was 56±8 years. 66% of patient showed myocardial viability, while 34% showed myocardial not viable. There was statistical difference between viable and not viable groups regarding the MPI; all patients in non-viable group shows scar with no reversable ischemia, while 68.2% of the viable group show reversible ischemia, and 31.8%had mixed scar with reversible ischemia, p < 0.001. EF could predict the viability, AUC= 0.992, at cut off value above 46%, the sensitivity was 0.949 and specificity was 0.934. IVSD could predict the viability, AUC= 0.950, at cut off value above 6.1 mm, the sensitivity was 0.974 and specificity was 0.967.