Background: The overall prognosis of patients with variant angina (VA) is relatively good. However, it is not well known about the long-term prognosis and influential factors for Korean patients with VA. Methods: From August 1996 to January 2007, 256 consecutive patients with VA were enrolled (215 men, 53짹9 years). Coronary spasm was confirmed during the coronary angiography in all patients by intravenous ergonovine provocation. Major adverse cardiac events (MACEs) were defined as myocardial infarction (MI), resuscitation from cardiac arrest, or repeated hospitalization due to recurrent chest pain. Results: 256 patients were followed for an average of 59 months (range, 5 months to 11 years). 31 patients (12.1%) were lost to follow-up. Cardiac death, a nonfatal MI, and MACEs occurred in 6 (2.3%), 3 (1.2%), and 52 (20.3%) patients, respectively. Survival, and survival without MI at 1, 3, and 5 years was 99%, 97%, and 97%, 99%, 96%, and 95%, respectively. MACEs-free survival at 1, 3, and 5 years was 91%, 81%, and 62%, respectively. MI at the initial presentation and current smoking were significantly associated with MACEs. Multivariate analysis showed current smoking to be the only independent predictor of MACEs-free survival (odd ratio 2.16; 95% CI 1.12 – 4.23; p = 0.022) (figure). Conclusion: Despite treatment with calcium channel blockers, recurrent episodes of angina were frequently observed whereas sudden cardiac death or non-fatal MI was rare. Cessation of smoking may reduce the incidence of recurrence.