Objectives: Coronary atherosclerotic plaques progress in a highly individual manner. Accurately predicting plaque progression will promote clinical management of atherosclerosis. The purpose of this study was to investigate the role of local biomechanics factors and vascular characteristics in coronary plaque progression and arterial remodeling. Methods: Computed tomography angiography-based three-dimensional reconstruction of the native right coronary artery was performed in vivo in twelve patients with acute coronary syndrome at baseline and 12-month follow-up. The reconstructed arteries were divided into sequential 3-mm-long segments. Wall shear stress (WSS) and von Mises stress (VMS) were computed in all segments at baseline by applying fluid-structure interaction simulations. Results: In total, 365 segments 3-mm long were analyzed. The decrease in minimal lumen area was independently predicted by low baseline VMS (-0.73 +/- 0.13 mm(2)), increase in plaque burden was independently predicted by small minimal lumen area and low baseline WSS (6.28 +/- 0.96%), and decrease in plaque volume was independently predicted by low baseline VMS (-0.99 +/- 0.49 mm(3)). Negative remodeling was more likely to occur in low-(55%) and moderate-VMS (40%) segments, but expansive remodeling was more likely to occur in high-VMS (44%) segments. Conclusions: Local von Mises stress, wall shear stress, minimal lumen area, and plaque burden provide independent and additive prediction in identifying coronary plaque progression and arterial remodeling.