The lower the heart rate the better image quality in multislice computed tomography (MSCT) coronary angiography. We prospectively assessed the influence of heart rate on per-patient diagnostic accuracy and image quality of MSCT coronary angiography and compared adaptive multisegment and standard halfscan reconstruction. A consecutive cohort of 126 patients scheduled to undergo conventional coronary angiography was examined with 16-slice CT. For all heart rate groups, per-patient diagnostic accuracy was significantly higher for multisegment than halfscan reconstruction with values of 95 vs. 79% (p < 0.05, <65 bpm, 38 patients), 85 vs. 66% (p < 0.05, 65-74 bpm, 47 patients), and 78% vs. 41% (p < 0.001, >74 bpm, 41 patients). Differences in diagnostic accuracy between adjacent heart rate groups were only significant for halfscan reconstruction for the comparison between the 65-74 and >74 bpm group (p < 0.05). The vessel lengths free of motion artifacts were significantly longer with multisegment reconstruction in all heart rate groups and for all coronary arteries (p < 0.005). For noninvasive MSCT coronary angiography, both per-patient diagnostic accuracy and image quality decline with increasing heart rate, and multisegment reconstruction at high heart rates yields similar results as standard halfscan reconstruction at low heart rates.