A prospective, multicenter study evaluated the accuracy of coronary magnetic resonance angiography (CMRA) in detecting coronary artery disease in patients referred for elective x-ray coronary angiography. CMRA was performed in 109 patients before x-ray angiography, and results were compared. Of 759 coronary segments, 636 (84%) were interpretable on CMRA. Of 94 clinically significant lesions (with ≥50% diameter reduction on x-ray angiography), 78 (83%) were detected by CMRA. Overall, CMRA had an accuracy of 72% (95% CI, 63-81%) in diagnosing coronary artery disease. Sensitivity, specificity, and accuracy for left main coronary artery or three-vessel disease were 100%, 85%, and 87%, respectively. Negative predictive values for any coronary artery disease and for left main artery or three-vessel disease were 81% (95% CI, 73-89%) and 100% (95% CI, 97-100%), respectively. CMRA reliably identified or ruled out left main coronary artery or three-vessel disease. The study found that CMRA is a noninvasive, accurate method for detecting coronary artery disease, particularly in patients with left main or three-vessel disease. It has high sensitivity and negative predictive value, suggesting it may be useful in ruling out clinically significant disease. The results support the use of CMRA to identify or rule out left main coronary artery or three-vessel disease. CMRA is not exercise-dependent and allows for free breathing, making it a comfortable and efficient method. The study also highlights the importance of standardized protocols for accurate results. CMRA is a promising noninvasive technique for diagnosing coronary artery disease, with potential to reduce the need for invasive x-ray angiography in certain cases. The study was supported by Philips Medical Systems and an American Heart Association grant.A prospective, multicenter study evaluated the accuracy of coronary magnetic resonance angiography (CMRA) in detecting coronary artery disease in patients referred for elective x-ray coronary angiography. CMRA was performed in 109 patients before x-ray angiography, and results were compared. Of 759 coronary segments, 636 (84%) were interpretable on CMRA. Of 94 clinically significant lesions (with ≥50% diameter reduction on x-ray angiography), 78 (83%) were detected by CMRA. Overall, CMRA had an accuracy of 72% (95% CI, 63-81%) in diagnosing coronary artery disease. Sensitivity, specificity, and accuracy for left main coronary artery or three-vessel disease were 100%, 85%, and 87%, respectively. Negative predictive values for any coronary artery disease and for left main artery or three-vessel disease were 81% (95% CI, 73-89%) and 100% (95% CI, 97-100%), respectively. CMRA reliably identified or ruled out left main coronary artery or three-vessel disease. The study found that CMRA is a noninvasive, accurate method for detecting coronary artery disease, particularly in patients with left main or three-vessel disease. It has high sensitivity and negative predictive value, suggesting it may be useful in ruling out clinically significant disease. The results support the use of CMRA to identify or rule out left main coronary artery or three-vessel disease. CMRA is not exercise-dependent and allows for free breathing, making it a comfortable and efficient method. The study also highlights the importance of standardized protocols for accurate results. CMRA is a promising noninvasive technique for diagnosing coronary artery disease, with potential to reduce the need for invasive x-ray angiography in certain cases. The study was supported by Philips Medical Systems and an American Heart Association grant.