Background: The prognosis of vasospastic angina (VA) may depend on the presence and severity of fixed lesion, but the relevant data are limited. Methods: We investigated 604 consecutive patients who were undergone iv ergonovine provocation from 2002 through 2010. Patients were categorized into four groups: negative provocation (Gr I, n=349), positive provocation accompanying normal angiogram (Gr II, n=41) or insignificant lesion (<50% DS) (Gr III, n=186) or significant lesion (���50% DS) (Gr IV, n=28). Primary outcome was the composite of major adverse cardiac event (MACE), defined as death, non-fatal myocardial infarction (MI), repeat hospitalization due to recurrent angina, or revascularization. Results: Of the 604 patients, presenting diagnoses were angina pectoris (92.5%), acute MI (2.3%), survivors of sudden cardiac arrest (1.7%), and atypical chest pain (3.6%). Ergonovine provocation was positive in 255 (42.2%) patients. During the follow-up of 3.7짹1.8 years, primary outcome was developed in 72 (11.9%) patients (10 death, 5 MI, 57 repeat hospitalization due to recurrent angina). Compared to negative provocation group (Gr I), primary outcome was significantly higher in positive provocation groups (Gr II+III+IV) (5.2% vs. 21.2%, p<0.0001). Among the positive provocation groups, the primary outcome was not different according to absence (Gr II) or presence (Gr III+IV) (22.0% vs. 17.1%, p=0.445) and insignificance (Gr III) or significance (Gr IV) (20.4% vs. 32.1%, p=0.158) of the fixed lesion. Multivariable logistic regression analysis identified the presence of fixed lesion as an independent predictor of the primary outcome (OR 2.08, 95% CI 1.004-4.309, p=0.049). Conclusions: The MACEs were developed in 21% of patients with documented VA and the presence of coronary fixed lesion was, even if insignificant, associated with unfavorable outcomes. This study suggests that patients with VA and fixed lesion should be followed up carefully.