The aim is to compare a compiled clinical routine cardiac magnetic resonance (CMR) imaging protocol performed at both 1.5 and 3 T in patients with suspected coronary artery disease (CAD) undergoing coronary X-ray angiography. CMR including adenosine perfusion and late gadolinium enhancement (LGE) at 1.5 T has been established for noninvasive detection of relevant CAD. However, little is known about the potential advantages of 3 T to detect CAD. Fifty-two evaluable patients (62.3 ± 10.2 years) were included into the study. All patients were scanned at both 1.5 and 3 T including adenosine stress and rest perfusion, and LGE imaging. CMR images were analyzed by two blinded readers in consensus. X-Ray angiography served as the reference method. A significant CAD was diagnosed by quantitative coronary analysis. Diagnostic accuracy of the combined analysis of perfusion and LGE imaging yielded better values at 1.5 and 3 T than the analysis of perfusion images alone. Specificity and sensitivity at 3 T was superior to 1.5 T in detecting coronary stenoses ≥50 % (90 vs. 75 % and 84.4 vs. 75 %) and ≥70 % (88 vs. 80 % and 96.3 vs. 88.9 %). This study showed that CMR at 3 T in a routine clinical setting is superior to 1.5 T in detection of significant CAD. 3 T might become the preferred CMR field strength for evaluation of CAD in clinical practice.