Background: Mid-term and long-term clinical outcomes of typical vasospastic angina documented by acetylcholine provocation test following conventional antianginal medication is known to be favorable but the follow up angiographic outcomes following adequate duration of conventional antianginal medication especially for the recurrent vasospasm is not reported yet. Methods: A total 46 patients (pts 28 men, Age; 59.9짹11.3 years) who has documented significant coronary spasm by incremental intracoronary acetylcholine (Ach) provocation test (A1 to A3, 20, 50 and 100關g) at baseline and medically managed with conventional antianginal medications including calcium antagonist, nitrate and/or nicorandil for at least 6 months but relatively poor responders were enrolled for the study. Repeat coronary angiography with same Ach provocation test protocol was performed. Results: Baseline characteristics were similar between the repeat provocation (+) group and (-) group. Mean ejection fraction was 57.1짹 5.0%. Mean follow up duration from the index test was 16.1짹11.8 months. Overall angiographic outcomes of repeat Ach provocation test showed (+) provocation test in 82.6% (38/46) and (-) test in 17.4% (8/46) although the pts complaints of continuing chest pain. There were 13 typical myocardial bridges (MB, 13/46=28.3%) were recognized. Interestingly, all the 13 MB were observed in the repeat (+) provocation group (0.0% vs. 28.3%, p=0.05) and the incidence of baseline spasm before provocation test was higher in the (+) provocation group (7.7% vs. 52.2%, p=0.05). Conclusion: Significant proportion of the vasospastic angina pts who are relatively poor response to conventional antianginal medication showed repetitive (+) provocation test. One-fifth of the pts may possibly be able to withdraw the medications with reassurances. Typical MB combined with baseline coronary spasm before the provocation test may be an important clue for worse angiographic & clinical outcomes especially for the recurrent vasospastic angina pts.