Abstract: Aim: To explore the value of 128-slice spiral CT in evaluating coronary artery disease by comparison with coronary arteriography. Methods: a total of 56 consecutive patients who showed coronary heart disease clinical symptoms or high risk factors in our hospital from March 2010 to January 2012, were given 128-slice spiral CT and given coronary arteriography in the 3-12 days. CAG results as the gold standard, evaluation of CTA coronaty atherosclerotic plaque the clinical value of quantitative analysis and qualitative analysis as well as to the coronary artery opening the discovery of abnormal detection rate. Result: according to the results of CTA, in 56 cases of patients, a total of 673 coronary artery segments can be evaluated, containing normal blood segments 505. 152 narrow or blocked segments caused by coronary artery plaques in 167 narrow or blocked and 4 abnormal coronary openings. In different branch of coronary artery, the incidence of mixed plaque than calcified plaques and soft plaque, the total incidence of different characteristics plaques in LMA (11%) and the incidence of soft plaque (0) are lower than those in LAD and RCA, and statistical difference was statistically significant (P ＜ 0.05). According to the CTA and CAG imaging quality, The accuracy of the plaques properties of CTA'was better than that of CAG, opening coronary anomalies shows that the accuracy is better than that of the CAG. Conclusion: 128-slice spiral CT coronary angiography as a noninvasive imaging method, the determination of coronary atherosclerotic plaque characteristics in CTA was superior to X-ray CAG. Opening coronary anomalies shows that the accuracy is better than that of the CAG and statistical difference was statistically significant (P ＜ 0.05). In some extent, the CTA can selectively instead of X-ray coronary angiography.