Objective To analyze the accuracy of 24h dynamic electrocardiogram (Holter) combined with 64-slice spiral computed tomography (MDCT) coronary angiography in the diagnosis of latent coronary heart disease (CHD). Methods A total of 68 cases of suspected latent CHD in our hospital were selected for the study, and the patients were given 24h Holter, 64 MDCT coronary angiography and coronary angiography (CAG). Take CAG was the gold standard for the diagnosis of latent CHD, and the diagnostic values of 24h Holter, 64 MDCT coronary angiography and the combined diagnosis for latent CHD were analyzed and compared. Results Of the 68 patients, 60 cases were diagnosed as latent CHD. Among the 481 coronary arteries, 264 were normal coronary lumens, 124 were mild lesions, 67 were moderate lesions, and 26 were severe lesions. 64 MDCT coronary angiography was accurate in 60 cases (88.24%), and the diagnosis of coronary stenosis was accurate in 187 segments (86.18%). 24h Holter was accurate in 55 cases (80.88%), and the combined diagnosis was accurate in 66 cases (97.06%). The sensitivity of combined diagnosis was significantly higher than that of 24h Holter (P<0.05), and the accuracy was significantly higher than that of 64 MDCT coronary angiography and 24h Holter (P<0.05). There were no significant differences in the sensitivity and accuracy between 64 MDCT coronary angiography and 24h Holter and in the specificity, positive predictive value and negative predictive value among the three diagnostic methods (P>0.05). Conclusion 24h Holter combined with 64 MDCT coronary angiography can improve the diagnostic accuracy of latent CHD, and has a good application prospect.