Introduction: Subsequent myocardial injury after percutaneous coronary intervention (PCI) can be developed in the high risk patient. We compared coronary plaque characteristics on multidetector computed tomography (MDCT) and cardiac enzyme elevation to investigate whether MDCT can predict subsequent myocardial injury after PCI. Methods: Sixty-eight patients (stable/unstable angina: 21/47; mean age: 64.2짹13.2 years) were enrolled. All the patients have normal Pre-PCI troponin T and cardiac CK-MB level. The plaque density value, remodeling index, spotty calcification and gross calcification were analyzed as plaque characteristics. Patients were divided into two groups according to the elevation of CK-MB >3x the upper normal limit (group A) and the normal CK-MB after PCI (group B). Results: Mean cardiac enzyme level was 21.4짹6.7 ug/L (group A, n=20) and 8.6짹2.6 ug/L (group B, n=48) respectively (p=0.004). The CT density value was smaller in the group A than in the group B (32.9짹18.7 HU vs. 105.1짹47.6 HU, p<0.001). Non-calcified plaques with spotty calcification were more frequent in the group A than in the group B (34% vs. 7%, p=0.010). The remodeling index was greater in the group A than in the group B (1.27짹0.21 vs. 1.01짹0.12, p=0.007). Gross calcification was similar in both groups. In the multivariate analysis, CT density value and spotty calcification were the independent predictors for post-PCI myocardial injury. Conclusion: Coronary plaque composition on cardiac MDCT can predict subsequent myocardial injury after PCI.