Background: The clinical significance of coronary vasospasm (CVS) in patients without significant coronary artery stenosis is not certain in this era of interventional cardiology. Moreover, role of spasm provocation testing using ergonovine and two-dimensional echocardiography (Erg Echo) and its prognostic implication have not been tested in long-term outcome study. Methods: We evaluated clinical data of consecutive patients who underwent both Erg Echo and coronary angiography (CAG) between Jan 1996 to Jan 2007. Before Erg Echo, absence of significant coronary artery stenosis was confirmed by CAG. Clinical events included cardiac death, myocardial infarction, follow-up revascularization, readmission due to intractable chest pain during follow up. The national vital statistics death file obtained through Dec 2006 was used for follow-up data. Results: A total of 564 patients (age 55짹10 years) were enrolled and Erg Echo was positive in 148 patients (26.4%, group 1), who showed higher rate of current smoker compared to those with negative Erg Echo (group 2). The mean follow-up was 4.3짹3.7 years. Cardiac death developed in 5 patients in group 1 and 6 in group 2 (p=.14). During follow-up, revascularization procedure (3.4% versus 1%, p=0.04) and hospital admission due to intractable chest pain (12.8% versus 6.3%, p=0.01) occurred more frequently in group 1. The 10-year clinical event-free rates were 71.9짹7.1% and 89.9짹2.2%, respectively (p=0.01). Conclusions: CVS could be documented in considerable numbers of patients with near normal coronary angiogram and significantly lower event-free survival rate in these selected patients supports prognostic impact of Erg Echo.