Objective: The aim of this study was to compare the diagnostic accuracy of 64-Slice Coronary Computer Tomography Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the identification of significant coronary artery stenosis (>50% luminal narrowing). Methods: A total of 120 patients suspected of having coronary artery disease were divided into two groups, with 60 patients in each group. Group 1 underwent CCTA and group 2 underwent MPI. Diagnostic accuracy parameters, image quality, radiation exposure, and procedure time were compared. Results: CCTA demonstrated higher sensitivity (90% vs. 80%, p = 0.049) and similar specificity (75% vs. 70%, p = 0.453) compared to MPI. Image quality was slightly superior in the CCTA group. Radiation exposure was significantly lower in the CCTA group compared to the MPI group (3.5 +/- 1.2 mSv vs. 9.4 +/- 1.7 mSv, p < 0.001). The procedure time for CCTA was also significantly less than that for MPI (10.3 +/- 2.1 minutes vs. 45.2 +/- 5.3 minutes, p < 0.001). Conclusion: CCTA showed superior sensitivity, image quality, and efficiency compared to MPI while exposing patients to a lower radiation dose. Further multicenter studies with larger patient populations are needed to validate these findings.