Objective To evaluate the ability of coronary computed tomography angiography (CTCA) to distinguish the features of coronary atherosclerosis plaques and to compare the differences of clinical diagnostic results and the high sensitivity C-reactive protein (HS-CRP) level of patients with plaques of different features. Methods Patients with suspicious coronary artery diseases received the coronary angiography (CAG) after the CTAT examination. According to the results of CAG and CTCA, patients with stenosis rate of coronary artery ≥50% and plaques were enrolled. Patients were divided into the soft plaque group, mixed plaque group, and calcified plaque group according to their CT values. Clinical features of groups were compared. The distribution of CTAT plaque characteristics of acute coronary syndrome (ACS) patients, stable ischemic heart disease (SIHD) patients, and patients with different HS-CRP levels were compared. The value of identifying ACS patients by the soft plaque combined with HS-CRP was evaluated. Results A total of 106 patients were selected. The soft plaque group, calcified plaque group, and mixed plaque group had 66 patients (62.3%), 13 patients (12.3%), and 27 patients (25.4%), respectively. CT values of three groups were (35.2±11.8) HU, (252.3±40.9)HU, and (88.3±19.6) HU, respectively. The differences of clinical features and levels of serum creatinine, troponin, and HS-CRP of three groups were not statistically significant (P>0.05) except that the age of the calcified plaque group was older than that of the soft plaque group and mixed plaque group (P=0.036). The differences of the distribution of plaque characteristics of the ACS group and SIHD group, and the normal HS-CRP level group and high HS-CRP level group were not statistically significant (P>0.05). Eight patients with soft plaques and high HS-CRP level were all diagnosed with ACS. Conclusion CTCA can distinguish coronary atherosclerosis plaques with different features. There is no difference in the distribution of plaque characteristics of patients with different clinical diagnostic results and HS-CRP levels. Patients with soft plaques and high HS-CRP levels were all diagnosed with ACS.