Aim To study the correlation between lipoprotein(a) [Lp(a)] level and coronary vulnerable plaque based on optical coherence tomography (OCT). Methods From January 2015 to August 2018, patients admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University who were diagnosed as coronary heart disease by coronary angiography were examined by OCT. The analysis of the relationship between lipoprotein (a) level and coronary vulnerable plaque were completed by multiple linear regression and other statistical methods. Results A total of 144 patients were enrolled. (1)According to the Lp(a) level, the patients were divided into two groups:Lp(a) ≤300 mg/L group (n＝99) and Lp(a) ＞300 mg/L group (n＝45). The lipid arc of plaque in Lp(a) ＞300 mg/L group was larger than that in Lp(a) ≤300 mg/L group (P＝0.021), and the incidence of vulnerable plaque was higher than that in Lp(a) ≤300 mg/L group (P＝0.001). (2)The patients were divided into vulnerable plaque group (n＝36) and non-vulnerable plaque group (n＝108) by OCT. There were significant differences in sex, smoking history, type 2 diabetes mellitus, body mass index, low density lipoprotein and Lp(a) between the two groups (all P＜0.05). Multivariate Logistic regression analysis showed that Lp(a), type 2 diabetes mellitus and low density lipoprotein were independent influencing factors of vulnerable plaque, and were predictors of vulnerable plaque occurrence. Conclusion The high level of lipoprotein (a) is independently correlated with coronary vulnerable plaques.