BACKGROUND: Ergonovine physiologically produces diffuse vasoconstriction less than 30% in epicardial arteries. However, severe diffuse multi-vessel vasospasm by ergonovine has not been exactly validated whether it is a true indicator of vasospastic angina or only a natural pharmacodynamic response. METHODS: Patients with suspected variant angina who underwent cardiac catheterization with intravenous ergonovine provocation test (antecubital vein, 0.4mg) were followed for a median period of 41.2짹13.7 months. Left and right coronary arteries were evaluated simultaneously. The patients were divided into 3 groups according to their response to ergonovine; no spasm (group I, n=68), diffuse multi-vessel spasm (group II, n=16) and other spasm (group III, n=12). The definition of diffuse multi-vessel vasospasm was vasoconstriction >70% of baseline luminal diameter, the length >2cm and developed in more than one major epicardial artery. RESULTS: A total 96 patients (56 male) were enrolled. The proportion of the male was 52.9%, 81.2% and 58.3% (p<0.05), the current or ex-smoker was 26.5%, 50.0% and 50.0% (p<0.05), the alcohol drinker was 20.6%, 43.8% and 33.3%, in group I, II and III, respectively (p<0.05). The mean value of triglyceride (TG); 125짹85, 181짹95 and 163짹76 (p<0.05), high density lipoprotein (HDL); 49짹12, 41짹10 and 49짹12 (p<0.05), respectively. Cardiovascular events of myocardial infarction and cardiac arrest occurred in 1 (1.5%), 1(6.3%) and 0 patient, respectively (p=0.42). Recurrence of chest pain within one year was observed in 6(10.3%), 5(33.3%) and 5 patients (45.5%), in group I, II and III, respectively(p=0.02). CONCLUSIONS: Diffuse multi-vessel spasm was more frequently induced by ergonovine in patients with male, current or ex-smoker, alcohol drinker. Although the prognosis of variant angina is relatively good, however, the rate of recurrence of chest pain is higher in diffuse multi-vessel spasm or other spasm than no spasm group. These results suggest that diffuse multi-vessel spasm can be considered as a type of variant angina and should be treated and followed up with similar manner like patients with previously known typical type of variant angina.