Abstract: Objective: To investigate the risk factors of plaque progression in patients with angina pectoris and their relationships with coronary computed tomography (CT) angiography. Methods: Clinical data of 236 patients with angina pectoris were retrospectively analyzed from January 2017 to January 2020. All patients were grouped according to whether plaque progression occurred, and the general information and coronary CT angiography indexes were compared between the two groups. A logistic regression model was used to evaluate the independent risk factors of plaque progression in patients with angina pectoris. The receiver operating characteristic (ROC) curve was delineated to analyze the clinical value of the prediction model based on coronary CT angiography indicators in predicting plaque progression risk. Results: There were significant differences in sex, the proportion of hyperlipidemia, proportion of statins, degree of stenosis, minimum lumen area, total plaque volume, RI, and CT-derived fractional flow reserve (FFR) between the two groups. The results of single factor analysis showed that the degree of stenosis, the minimum lumen area, plaque volume, the volume of non-calcified plaque, RI, and CT-FFR levels were related to the plaque progression in patients with angina pectoris. Univariate analysis showed that the degree of stenosis, minimum lumen area, plaque volume, non-calcified plaque volume, RI, and CT-FFR levels were associated with plaque progression in patients with angina pectoris. Multivariate analysis showed that RI and CT-FFR levels were independent factors of plaque progression in patients with angina pectoris. ROC curve analysis showed that the combination of stenosis degree + RI + CT-FFR was better than that of simple stenosis degree and stenosis degree + RI in predicting the area under the curve of plaque progression. Conclusion: RI and CT-FFR levels are important factors leading to plaque progression in patients with angina pectoris. The prediction model based on RI and CT-FFR can more accurately identify plaque progression.