The purpose of this work was to assess technical performance of a prototype high-ratio (r29), 80 line cm−1 grid for imaging conditions which mimic those for adult cardiovascular angiography. The standard equipment r15, 80 line cm−1 grid was used as a reference. Plastic Water® LR phantoms with thickness in the range 20–44 cm were used to simulate adult patient attenuation and scatter. Grids were tested using x-ray field of view 20 and 25 cm and x-ray source to detector distance (SID) 107 and 120 cm. The primary transmission fraction (TP ) was measured using both narrow beam geometry and a lead beam stop (BS) technique. Scatter transmission (TS ) was measured with the lead BS technique. The quantum signal to noise ratio improvement factor (K SNR) was used to describe relative grid performance. The experimental conditions required revised theory to assess grid performance. Theory to account for the detector glare and underestimation of scatter intensity by the lead BS method was developed. Also, novel K SNR theory was developed to allow direct comparison of two grids operated at different SID. Mean TP was modestly lower for the r29 versus r15 grid (0.69 versus 0.75). When tested under equivalent scatter condition, TS of the r29 grid was approximately ½ that of the r15 grid (0.18 versus 0.34). K SNR of the r29 grid at SID 120 cm compared to the r15 grid at SID 107 cm increased linearly with phantom thickness (range 1.0 to ∼1.16). Findings of this work indicate that the r29 grid used at SID 120 cm is expected to provide improved image quality (or reduced patient radiation dose) when compared to the r15 grid used at SID 107 cm for adult cardiovascular patients and that the potential benefit of the r29 grid increases with patient thickness >20 cm.