Background – Early repolarization (ER), which is characterized by an elevation of J-point, is sometimes associated with fatal arrhythmia and sudden cardiac death in patients without structural heart disease. Because ER can be observed in myocardial ischemia, this study was performed to investigate the prevalence and prognostic significance of ER in patients with vasospastic angina (VA). Methods - We assessed the ER pattern in 281 VA patients (mean [짹SD] age, 50.5 짹 7.9 years), and the prognostic modulation of ER-associated risk by ST-segment variations. Results -Any type of ER ��� 0.1 mV in inferior and/or lateral leads was persistently observed after chest pain in 60 (21.4%) VA patients. During the follow up period of 7.6 짹 4.7 years, patients with ER had higher incidence of cardiac events including cardiac death, aborted sudden cardiac death or fatal arrhythmia than those with no ER (20.0% vs. 5.4%, p=0.001). Patients with ER ��� 0.1 mV and horizontal/descending ST variant (n=18) had an increased age- and sex-adjusted hazard ratio of cardiac events (relative risk 8.12; 95% confidence interval 3.45-19.12). When modeled for ER in inferior leads and horizontal/descending ST-segment variant, the hazard ratio of cardiac events increased to 8.89 (95% confidence interval 3.78–20.91). However, in subjects with ascending ST variant, the relative risk for arrhythmic death was not significantly increased. Conclusion - ER was observed in a fifth of VA patients. The ER ��� 0.1 mV and horizontal/descending ST variant was associated with an increased risk of cardiac events in VA patients.