In contrast to chronic myocardial infarction, data concerning the value of cardiac magnetic resonance imaging in patients with acute onset of chest pain are still rare. Even in the presence of characteristic clinical parameters, cardiac magnetic resonance imaging might provide independent evidence especially in the absence of typical ECG alterations and prior to biomarker elevation. Besides the ability to demonstrate wall motion abnormalities cardiac magnetic resonance imaging gains additional potential as to the detection of myocardial edema, microvascular obstruction (no-reflow) and myocardial necrosis. However, cardiac magnetic resonance imaging is expensive and time-consuming, and therefore may not be cost-effective. At present, a lack of sufficient diagnostic and prognostic data would make cardiac magnetic resonance imaging unsuitable for routine stratification of chest pain patients in an emergency department.