Aim To evaluate relationship between positive vascular remodeling and plague composition in culprit coronary artery. Methods The study analyzed 41 patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. Patients were divided into positive remodeling(PR) group or negative remodeling (NR)group according to remodeling index(RI). Results Compared with negative remodeling patients, patients with positive remodeling had bigger EEM area (17.95±4.25 mm² vs 11.44±2.13 mm²), luman area (6.02±1.85 mm² vs 4.98±1.06 mm²), and plague burden(63.83%±7.89 % vs 63.83%±7.89%; P<0.05). Virtual histology analysis showed PR group had higher necrotic core (30.38%±9.33% vs 17.19%±11.31%; P=0.001) and lower fibrous ratio (44.61%±14.93% vs 61.08%±14.81%; P=0.002) than NR group. There were no significant difference in calclium area and fibrous-fatty area between the two groups. RI showed significant positive correlation with necrotic core(r=0.373, P=0.023). Conclusions Positive remodeling in a culprit lesion is associated with the increased ratio of necrotic core.Positive remodeling may be one characteristic of plaque vulnerability.