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Background and Objectives It is well known that coronary spasm can cause acute coronary syndrome ACS , such as unstable angina or acute myocardial infarction as well as variant angina. However, the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore, we investigated the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram CAG and suspected variant angina. Meterials and Method From July 1999 to June 2000, 53 consecutive patients were enrolled in this study mean age 56 10, 44 male . The clinical manifestations of the patients included acute myocardial infarction 8 , unstable angina 17 and suspected variant angina 28 . Ergonovine maleate was administered intravenously 50 g at 5 minute intervals up to total cumulative dosage 350 g with continuous echocardiographic monitoring. The positive criterion of this test was a reversible regional wall motion abnormality seen on echocardiography. Results This test was completed in all patients without major cardiac event or malignant arrhythmia. Fourteen patients 14/53, 26% showed a positive test their clinical diagnosis was AMI in 2, unstable angina in 6, and variant angina in 6. Four cases were positive without chest pain or electrocardiographic change. Conclusion Ergonovine echocardiography is a safe and useful method for the diagnosis of coronary vasospasm in ACS with normal CAG and suspected variant angina without ST segment change. Korean Circulation J 2001 ; 31 4 : 405-410