Background: Patient with variant angina (VA) has a wide spectrum of vascular morphology except a high incidence of negative remodeling. Although vasospasm might be considered as a presentation of early artherosclerosis, it has not been clear whether there is any relationship between vascular morphology and clinical event in VA. Methods: To evaluate intravascular ultrasound (IVUS) findings could predict clinical events in VA, we consecutively performed IVUS study in 48 patient (36 males, mean age 49짹10 years) with VA documented by ergonovine provocation test. We analyzed quantitative IVUS parameters including minimal luminal diameter(MLD), minimal lumen area (MLA), vessel area (VA), plaque area(PA) and plaque burden (%PB) and vascular remodeling. The clinical follow-up was conducted with regard to end points, which included cardiac death, non-fetal MI, target vessel revascularization (TVR) or recurrent angina (26짹23 months, 6~77 months). Recurrent angina was defined as chest pain responded by nitroglycerine despite of medication and abstaining from smoking. Results: During follow-up period, any event occurred in 10 out of 48 patients (20.8%, cardiac death 0, non-fetal MI 0, TVR 3, recurrent angina 7). MLA and VA of the lesion were related with clinical events. Negative vascular remodeling was also associated with clinical events. Multivariate analysis showed that the negative arterial remodeling was the only independent predictor of long term clinical cardiac events in VA (95% CI for Exp(B) 0.086, 0.0076~0.9779, p=0.0479). Conclusion: Vascular morphology especially vascular remodeling was related with clinical event represented as recurrent angina or TVR. Serial IVUS study might be needed to further understand the mechanisms of clinical presentation according to a progression of vascular morphology in VA.