PURPOSE: The aim of the study was to assess the feasibility and additional diagnostic information of cardiac MRI as a supplement to state-of-the-art MR angiography (MRA) in the case of vascular risk patients. Therefore, the prevalence of delayed myocardial enhancement (DE) was determined in patients suffering from peripheral artery disease (PAD) and a clinical follow-up was evaluated after 2 years. MATERIALS AND METHOD: 87 consecutive patients (ages 66 +/- 10 years, 67 males) with symptomatic peripheral arterial occlusive disease (n = 68) or abdominal aortic aneurysm (n = 19) were examined using delayed cardiac enhancement (DE) within the clinical indication of MRA at a 1.5T system. A follow-up examination was carried out two years later (24 months +/- 4 months) with regards to cardiac events (cardiac death, myocardial infarction or acute coronary syndrome, heart insufficiency, coronary revascularization). RESULTS: In total, 40 / 87 patients had myocardial infarctions shown in MRI (46 %). In 25 patients (29 %), the myocardial infarction was already known, while in 15 patients (17 %) an occult progressing infarction was diagnosed (38 % of the myocardial infarcts). Follow-up data was able to be obtained after 2 years for 82 patients. 15 patients had a major cardiac event during the follow-up period, and 10 (67 %) of them already showed DE in the MRI. In the group with occult progressing infarctions, cardiac events occurred in 40 % (6 / 15 patients, cardiac death n = 1, ischemia n = 4, heart insufficiency n = 1, bypass n = 1), in patients with known infarction in 17 % (4 / 23 patients, cardiac death n = 1, ischemia n = 3, bypass n = 2) and in 11 % of patients without myocardial scars (5 / 44 patients, cardiac death n = 1, ischemia n = 2, heart insufficiency n = 2). CONCLUSION: Cardiac MRI in combination with MRA was feasible and showed a high prevalence of known and unexpected myocardial infarctions. This was of prognostic relevance in the follow-up 2 years later. Therefore, this enables important additional information regarding to the risk stratification and eventually targeted therapy in risk patients with PAD.