Background: It is not well known about the incidence, clinical feature, and long-term outcomes of clinically or angiographically insignificant abnormal coronary artery spasm during ergonovine provoked coronary angiography (ErgCAG). Methods: From January 2005 to December 2009, 1,178 consecutive patients who underwent ErgCAG were included (754 men, 55짹11 years). We divided the patients with three groups according to the result of ErgCAG; negative (group 1, n=719 (61%)), intermediate (group 2, n=156 (13%), and positive (group 3, n=303 (26%)), and compared the clinical risk factors, angiographic findings, and MACEs between three groups. Clinically or angiographically insignificant abnormal coronary spasms were defined as an ���intermediate spasm���; diffuse (more than two segments) significant (more than 70% of diameter stenosis) spasm or focal intermediate (between 50% and 70% of diameter stenosis) spasm. Major adverse cardiac events (MACEs) were defined as cardiac death, myocardial infarction (MI) and revascularization. Results: 1,178 patients were followed for an average of 30 months (range, 2 months to 5.5 years). The male gender, and calcium-channel blocker and/or nitrate use during follow-up were more prevalent in group 2 and group 3 than group 1 (p<0.001). MACEs of the group 1, 2, and 3 occurred in 13 (1.8%), 4 (2.6%), and 14 (4.6%), respectively, and MACEs-free survival times were 65.5, 63.3, and 64.1 months (p=0.60), respectively. Cox regression survival analysis showed the more than intermediate coronary artery disease to be the only independent predictor of MACEs-free survival in all three groups (odd ratio 4.143; 95% CI 1.966 – 8.731; p < 0.001). Conclusion: Despite treatment with calcium channel blockers or nitrate for symptom or risk factor control, the severity of the coronary artery disease might be the only determinant factor for cardiac events in patients with insignificant or significant abnormal coronary spasm which was frequently observed during ErgCAG.