Background It has been known that exercise stress echocardiography (ESE) has a clinically useful level of sensitivity and specificity for the detection of coronary artery disease (CAD) in women. But, there are limited data on the ability of ESE to predict clinical outcomes in female patients with no history of CAD. The purposes of this study are 1) to define the diagnostic accuracy of ESE in patients with no history of CAD, 2) to evaluate the clinical outcomes of coronary angiography, revascularization, and cardiac events in Korean female patients undergoing ESE. Methods & Results A total of 3,423 patients (mean 57짹10 yrs) among 3,938 female patients with no prior history of CAD undergoing ESE during 15 years were assessed. Positive results for ESE (newly developed regional wall motion abnormality) were seen in 144 patients (4.2%). Conventional coronary angiogram or coronary computed tomography angiogram was obtained in 358 patients (10.5%). Significant CAD was diagnosed in 22 patients (none of 289 patients with ESE negative results and 22 of 69 patients with ESE positive results). The sensitivity and specificity of ESE were 100% and 85% respectively. ESE had better sensitivity, negative and positive predictive value than exercise electrocardiography (Table 1). Among 440 patients with available clinical outcomes, myocardial infarction and revascularization occurred in 6 patients (5.8%) only with ESE positive results (Table 2). Conclusions ESE is effective for making the diagnosis of CAD in patients without a history of CAD in a Korean female population. ESE negative results seemed to be associated with favorable cardiac outcomes but its prognostic value in this population needs to be proved in a large-scale prospective study.