Objective To investigate the value of 64-slice spiral CT in the evaluation of the location, properties and stability of coronary plaque. Methods The clinical data of 157 cases of CHD (observation group) and 157 cases of non-acute coronary syndrome (control group) underwent 64-slice spiral CT examinations in our hospital were analyzed retrospectively. Images were reconstructed by maximum intensity projection (MIP), curved planar reformation (CPR), multiple planar reformation (MPR) methods. Then the CT value of coronary plaque was calculated based on the digital image postprocessing algorithms. Results The total detection rate of plaque was 100% (157 cases) in the observation group and 78.98% (124) in the control group; the observation group had higher detection rate of soft plaque and mixed plaque as well as lower detection rate of calcified plaque than those of the control group (P<0.05), a total of 520 plaques were checked, including 157 cases of arteriostenosis in observation group and 201 cases of arteriostenosis in the control group. The coronary artery stenosis rate in the observation group was higher than that in the control group (P<0.05). The coronary artery stenosis was severe in 89 cases, moderate in 46 cases and mild in 40 cases in the observation group, and these were 24 cases, 19 cases and 158 cases in the control group, respectively. The severe coronary artery stenosis rate and normal rate in the observation group were significantly higher than those in the control group (P<0.05). The sensitivity and specificity of 64-slice spiral CT in the evaluation of mild, moderate and severe coronary artery stenosis were 73.24%/95.69%, 80.78%/96.54% and 87.54%/97.24%. The distribution of the plaques ranked in a descending order was LAD2, LAD1, RCA1/D1, LCX1, LM/ LAD3, PLV/PDA/LCX2, RCA3, D2/OM, RCA2. The types of plaque (calcified, noncalcified, mixed) were related to the coronary artery stenosis degree (mild, moderate and severe) (P<0.05). Conclusion 64-slice spiral CT can evaluate the location, properties and stability of coronary plaque effectively, which is worthy of clinical application.