Objective This paper is to explore the application value of 128-slice spiral CT coronary artery imaging in patients with coronary heart disease (CHD). Methods One hundred and twenty four patients with coronary heart disease (CHD) admitted in the Radiology Department of the Hospital were selected as research subjects, and retrospective analysis and summary were made according to clinical data. All patients were subject to spiral coronary CT artery imaging and coronary artery angiography, coronary angiography result was treated as the gold standard, the sensitivity and specificity of 128-slice spiral CT coronary artery imaging in the diagnosis of coronary heart disease (CHD) were analyzed. Results Coronary angiography showed 58 patients had mild coronary artery stenosis, 62 patients had moderate stenosis, 52 patients had moderate coronary artery stenosis, and 17 patients suffered from occlusion. 128-slice spiral CT coronary artery imaging showed 67 patients had mild coronary artery stenosis, 53 patients suffered from moderate coronary artery stenosis, 46 patients had severe coronary artery stenosis, 17 patients suffered from occlusion, there was no statistically significant difference (P>0.05) when two types of diagnostic methods were compared. The sensitivity and specificity of spiral CT coronary artery imaging in the diagnosis of coronary artery stenosis hit 95.9% and 96.3% respectively, positive predictive value hit 92.3%, and negative predictive value hit 97.9%. Conclusion 128-slice spiral CT coronary artery imaging delivers important value in the diagnosis of coronary heart disease, and it is comparable to coronary angiography. This technique is provided with high sensitivity and specificity, and it can improve the diagnostic rate, becoming a type of noninvasive and complete inspection way and ideal option for the diagnosis of coronary heart disease (CHD).