Objective To compare coronary artery abnormality between patients with silent myocardial ischemia (SMI)and pa-tients with symptomatic myocardial ischemia using coronary artery CT angiography.Methods Forty-three patients with SMI and 45 patients with symptomatic myocardial ischemia were collected and underwent coronary CT angiography using 128-slices spiral CT scanner,respectively.Results Stenosis of coronary artery detected in 23 patients with SMI was (23/43,53.49%),and stenosis in 21 patients with symptomatic myocardial ischemia was (21/45,46.67%).The difference of incidence had no statistical significance, but the degree of stenosis and the number of stenosis vessel had statistical significance(P <0.05).The number of atherosclerotic plaque of coronary artery detected in patients with symptomatic myocardial ischemia was significantly more than that in patients with SMI(P <0.05).Conclusion There are no significant difference in the incidence of coronary stenosis between the patients with SMI and patients with symptomatic myocardial ischemia.However,the degree of stenosis and incidence of atherosclerotic plaque are sig-nificant different.