OBJECTIVES: To investigate whether the use of cardiac magnetic resonance imagining (CMR)  to diagnose cardiac risk saves costs by leading to reductions in referrals for cardiac catheterization. METHODS: Two hundred and eighteen subjects were matched to a prior sample in which CMR was demonstrated to reliably stratify patients regarding their risk of major cardiac events. Propensity scoring methods were used to match on comorbidity profiles, demographics, coronary artery disease (CAD)-related clinical presentation, and CAD risk as measured by their Morise scores. The matched sample included adult subjects with suspected coronary artery disease who were evaluated by stress CMR.  We identified the proportion of patients who were able to avoid cardiac catheterization based upon the results of their CMR tests.  Given this information, and data on the costs of cardiac catheterization and CMR tests, a net cost analysis was performed. RESULTS: CMR use substantially reduces the need for cardiac catheterization by 62.4%.  In countries like Germany CMR is not yet reimbursed.  Assuming CATH costs of €631, the breakeven-level for CMR costs at which it is cost neutral is €393.  These results were robust in sensitivity analysis.  Cost savings are greatest for patients with lowest risk of CAD as measured by their baseline Morise scores. However, cost savings are likely for all Morise sub groups examined, with the exception of patients at the highest risk of CAD as measured by their Morise score. CONCLUSIONS: CMR is a safe and cost effective approach to evaluating patients with suspected CAD.  Even at reimbursement levels up to €390, the use of CMR as a gatekeeper saves money.