Objective To analyze the diagnostic value of 64 slice dual-source spiral CT (DSCT) and coronary angiography (CAG) in coronary vunerable plaques. Methods 63 patients with coronary heart disease treated in our hospital for typical symptoms from July 2013 to July 2015 were selected as the research objects. 64 slice dual-source spiral CT and coronary angiography were performed respectively. The value of 64 slice dual-source spiral CT in the diagnosis of coronary vulnerable plaques was evaluated. Results DSCT detected 141 lesions of coronary stenosis while CAG detected 156 (P>0.05). Taking CAG as the standard, the sensitivity of DSCT was 93.6%, specificity was 94.3%, the negative predictive value was 97.0% and the positive predictive value was 84.6%; Soft plaques, fibrous plaques and hard plaques in patients with stable angina pectoris detected by DSCT accounted for 16.7%, 26.7% and 56.7%, respectively. The proportion of soft plaques was significantly lower than that in the unstable angina pectoris group while the proportion of hard plaques was significantly higher (P<0.05); There were 156 lesions of coronary plaques detected by DSCT, which was not different from the detection rate of CAG, including 21 mild, 66 moderate and 57 severe stenosis. Mild and moderate stenosis were mainly with soft plaqies while severe stenosis was with hard plaques. The proportion of hard plaques in the severe group was significantly higher than those in mild and moderate stenosis group (P<0.05). Conclusion DSCT has high accuracy in the diagnosis of severity of coronary stenosis and the nature of plaques in patients with coronary heart disease. It has high conformity with CAG and has positive value for guiding the prevention and treatment of coronary heart disease related cardiovascular complications