Objective To explore the potential of forward projected model-based iterative reconstruction solution (FIRST) in improving the image quality of coronary artery stents in CT angiography (CTA). Methods A total of 44 patients with 59 coronary stents who underwent coronary CTA in our hospital were included retrospectively. The images were reconstructed with FIRST-Cardiac (FIRST-C), FIRST-Cardiac Sharp (FIRST-CS), adaptive iterative dose reduction 3D (AIDR-3D) standard and filtered back projection (FBP) respectively. All images were evaluated objectively, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of stent lumen, visible inner diameter of stent, and the stent lumen attenuation increase ratio (SAIR). Two radiologists visually evaluated the image quality of the stents and performed double-blind subjective scoring with 5-point scale (1=poor, 5=excellent). The difference between objective and subjective evaluation was compared between the four groups. Results Objective analysis of image quality showed that there were significant differences in SNR, CNR, visible inner diameter of stent and SAIR among these four groups (P<0.001). The SNR and CNR of FIRST-C group were significantly better than the other three groups (P<0.05)丨 the visible inner diameter of stent in the FIRST-CS group was the largest (1.96±0.42) mm, and the SAIR was the lowest 0.32±0.27, which was better than the other three groups. Among the subjective scores, FIRST-C and FIRST-CS images met the diagnostic requirements. The score of FIRST-CS group was the highest, which was sequentially higher than that of FIRST-C, AIDR-3D group and FBP group. Conclusion Compared with AIDR-3D and FBP, FIRST helps to improve the image quality of coronary stent. FIRST-C can effectively improve the SNR. FIRST-CS has more advantages in stent lumen visualization and can provide high-quality images for clinic