Objective The aim of this study was to investigate the impact of a motion-correction algorithm on diagnostic accuracy of coronary computed tomography angiography (CCTA) within 1 heart beat in patients with high heart rate (HR) using a 256-row detector CT. Method Sixty-four consecutive patients with known or suspected coronary artery disease (symptomatic) and with HR of 75 beats per minute or greater (mean [SD] HR, 82.6 [7.3] beats per minute) undergoing CCTA and invasive coronary angiography within 4 weeks were prospectively enrolled. Coronary computed tomography angiography was performed with a 256-row detector CT (Revolution CT, GE Healthcare) using prospectively electrocardiography-triggered volume scan in 1 heart beat. All images were reconstructed using standard (STD) algorithm and a motion-correction algorithm reconstruction (Snapshot Freeze SSF; GE Healthcare) technique. The image quality of coronary artery segments was evaluated by 2 experienced radiologists using a 4-point scale based on the 18-segment model. Diagnostic accuracy was compared between STD and SSF for significant lumen stenosis (50%) of each segment with invasive coronary angiography as the reference standard for determining significant stenosis. Results The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value with STD and SSF were 93.7%, 85.1%, 50.2%, and 98.8% versus 91.9%, 95.8%, 77.9%, and 98.7% on per-segment assessment; 98.7%, 74.0%, 62.9%, and 99.2% versus 96.2%, 94.4%, 77.9%, and 98.7% on per-artery assessment; and 100%, 14.3%, 70.5%, and 100% versus 100%, 85.7%, 93.5%, and 100% on per-patient assessment, respectively. There was a significant difference in accuracy between STD and SFF on per-patient level 71.9% versus 95.3%, on per-artery level 81.6% versus 94.9%, and per-segment level 86.3% versus 95.3%, respectively. The area under receiver operating characteristics curve analysis also showed a significant improvement on diagnostic performance with the SSF technique versus with the STD algorithm on per-patient level (P < 0.001), with corresponding area under the curve being 0.91 (95% confidence interval, 0.79-1.00) and 0.60 (95% confidence interval, 0.44-0.75). The mean effective dose was 2.0 mSv. Conclusions Coronary computed tomography angiography can be performed in patients with high HR within 1 heart beat yielding low radiation dose. The use of SSF technique reconstruction for 1 heart beat CCTA achieves significant improvements in image quality and diagnostic value.