Objective To explore the value of 64 layers spiral CT coronary artery imaging and DSA angiography in the diagnosis of coronary artery disease. Methods There were 186 cases of patients trested in our hospital's cardiovascular internal medicine from February 2011 to August 2014 ,which were diagnosis with coronary heart disease (CHD) and examined by 64 layers spiral CT coronary artery imaging and DSA angiography (MSCTA). Take a retrospective statistical analysis of clinical data of all patients, DSA as reference, the comparative analysis of DSA for coronary number of stenosis and pathology of the degree and the detection of internal plaques properties. Results Compared each segment narrow coronary artery branches and the corresponding degree of coronary artery detection rate of MSCTA with DSA, no obvious difference were found , there is no significance statistical (P > 0.05); MSCT of plaque slightly below the inspection results of DSA, non calcified plaques with calcified plaque detection rate compared with DSA, no obvious difference, there is no statistical significance (P>0.05). Conclusion MSCTA similar to narrow the positive rate of coronary artery with DSA, clinical diagnosis effect, can accurate and intuitive display coronary artery imaging, and has the characteristics of a noninvasive, safe, and has high value of clinical diagnosis.