Abstract: Objective To investigate the predictive value of electrocardiogram (ECG) test for malignant ventricular arrhythmia (MVA) in patients with variant angina (VA), and to provide reliable monitoring basis for the occurrence of MVA in VA patients. Methods A total of 90 patients with VA were admitted to our hospital from June, 2013 to June, 2017, and 67 patients with VA were selected to VA group and 23 patients with VA combined with MVA were selected to MVA group. Logistic regression analysis was used to explore the relationship between ECG parameters and MVA. The area under the curve (AUC) of ROC was used to analyze the predictive value of ECG parameters on MVA. Results In the acute episode, cQTd, cTp-e, Tp-e/QT, cTp-ed and STE of MVA group were significantly higher than those of VA group (P<0.05). The AUC value of cTp-e, cTp-ed, Tp-e/QT and STE were significantly higher than that of cQTd (P<0.05), the AUC value of Tp-e/QT, cTp-ed were significantly higher than those of cTp-e and STE (P<0.05); There was no significant difference on the AUC between Tp-e/QT and cTp-ed (P>0.05), and there was also no significant difference on the AUC between cTp-e and STE (P>0.05). Logistic regression analysis showed that there was a close correlation between cQTd/QT, cTp-ed, STE and MVA in VA patients (P<0.05). Conclusion ECG detection can effectively predict MVA in patients with VA. Tp-e/QT and cTp-ed are relatively stable and have higher predictive value, which can be used as a valid indicator of the risk of MVA in patients with VA.