Coronary artery spasm is an uncommon, but well recognized etiology for acute myocardial infarction. However, cardiogenic shock with myocardial infarction resulting from simultaneous multiple coronary artery spasm has been rarely reported, and not in Korea. We experienced recently such a case in a 50-year-old Korean man without previous diagnosis of variant angina. The patients developed severe chest pain accompanying ST-segment elevation in multiple leads, was immediately brought to cardiac catheterization because of cardiogenic shock. Coronary angiogram revealed a severe spasm of three major epicardial arteries simultaneously, which was promptly relieved by intracoronary administration of isosorbide dinitrate. This case calls for attention to rule out the potential mechanism of coronary spasm even in the most severe episodes of acute coronary syndrome.