Magnetocardiography (MCG), a non-invasive diagnostic modality that measures the magnetic field arising from the electrical activity of the heart cycle, has been found to be superior to ECG in detection of myocardial ischemia in patients with acute chest pain. The objective of this pilot study is to evaluate MCG using Cardioflux (MCG-CF), a novel MCG analysis system, in the workup of ED observation unit (EDOU) chest pain patients by comparing MCG-CF with stress testing (ST) and/or coronary angiography (CA) to identify myocardial ischemia. This is a prospective pilot study of ED chest pain patients of low-intermediate risk placed in an EDOU between August 2017 and February 2018 evaluated with a resting 90-second MCG-CF in addition to ST and/or CA. The MCG hardware unit is comprised of patient table, sensor plate positioned over the chest, and magnetic shield enclosure. Exclusion criteria include metal in chest area, inability to fit into the unit or complete the scan. A negative MCG-CF is defined as findings correlating to < 50% stenosis and a positive MCG-CF as 50% - 69% and ≥ 70% stenosis. CA is the gold standard if both ST and CA are performed. Assessment of further diagnostic testing with ST or CA and major adverse cardiac events (MACE) at 30 days after discharge performed via phone as well as hospital electronic medical records. Of 125 consented patients, 101 underwent MCG-CF and 24 were excluded. Mean age was 56 years, 53.6% were male and 56.5% African American. Of 78 patients with negative MCG-CF, 72 have corresponding negative ST (66) or CA (6), and 6 had positive ST (1) or CA (5). Of 23 patients with a positive MCG-CF, 3 had a corresponding positive CA, and 20 had a negative ST (16) or CA (4). Only 9 patients in the entire cohort were positive for ischemia: ST (1), CA (8). Using ST or CA as the gold standard, the sensitivity with 95% CI for MCG-CF is 33.3% [7.5%, 70.7%], specificity 79.4% [68.4%, 86.2%], PPV 13% [5.2%, 29.0%] and NPV 92.3% [88.2%, 95.1%] for ≥50% stenosis and 28.6% [3.7%, 71.0%], 87.1% [78.6%, 93.2%], 14.3% [4.4%, 37.6%] and 94.2% [91.0%, 96.3%] respectively for ≥70% stenosis. Additionally, 30-day follow-up was completed via review of electronic medical records (covers 3 local hospitals), no patients had ST, CA or MACE post discharge. Phone follow-up was attempted for adverse events however only 25.7% were successfully contacted. This pilot study of a novel diagnostic test shows a resting 90-second MCG-CF has excellent specificity and NPV especially in patients with critical stenosis. No patients had further cardiac testing or MACE 30-days post discharge. A larger study to better assess accuracy in ruling out significant stenosis/ischemia is needed. Also, given the low prevalence of disease in this study cohort, a larger study that also includes high-risk chest pain patients is needed to better assess the accuracy of MCG-CF in detecting cardiac ischemia and could assess whether MCG-CF is superior to ST and would therefore be a faster non-invasive diagnostic modality in the evaluation of ED patients with chest pain.