Abstract: Objective: To explore the application value of 128-slice spiral CT angiography in the diagnosis of acute chest pain. Methods: Acute chest pain in 36 patients were highly suspected to be caused by acute myocardial infarction，pulmonary embolism and aortic dissection aneurysm. All cases were detected by 128-slice spiral CT angiography. The vessels were remodeled by volume rendering，multiplanar reconstruction and high density projection technique， the anatomical lesions in pulmonary artery，pulmonary vein， coronary and aorta were observed through different angles. Results: The 3D images of pulmonary artery，pulmonary vein， left and right coronary artery and aorta of all cases could be clearly displayed. Coronary artery stenosis and occlusion in 13 cases，aortic dissecting aneurysm in 5 cases，pulmonary artery embolism in 5 cases， other diseases in 9 cases and normal in 4 cases were found. Conclusions:128-slice spiral CT scaning can determine the diagnosis of large vessel disease in pulmonary artery，pulmonary vein， coronary artery and aorta，which has the important significance in the clinical diagnosis and treatment of chest pain triad.