Background: The exercise ECG (ETT) is a cost-effective, non-invasive method that provides valuable data in assessment and risk stratification of coronary artery disease (CAD). This study aims to demonstrate the importance of using this testing modality in evaluating patients with CAD. Methods: This analytical cross-sectional study was conducted among 3000 patients who were referred for ETT at the cardiology unit of Colombo South Teaching Hospital, Sri Lanka between November 2018 and February 2020. ETT was done using classical Bruce protocol and majority of ETT positive patients were referred for Coronary Angiogram (CA). Follow up was conducted up to 2 years post enrollment. Results: Among the 3000 patients, 797(26.6%) positive, 1896 (63.2%) negative and 307 (10.2%) inconclusive ETT outcomes were found. 698 (23.3%) patients were referred for a CA in which 338 (48.4%) underwent the procedure. The frequent indication of ETT was chest pain (67.1%). Hypertension, Dyslipidemia, Diabetes Mellitus, chronic kidney disease (CKD), and Smoking were the risk factors present in the population with 57.3%, 62.3%, 34.2%, 1.7% and 4.9% respectively. Conclusion: Among the positive ETT outcome, majority were males 421(52.8%) and older (?41years) and NSTEMI was the common clinical pattern. Dyslipidemia was the commonest risk factor in the study population. Past history of CAD was not significant in positive ETT population. Majority of patients on beta blocker achieved the target heart rate. Exercise induced ST depression mainly demonstrated in inferolateral leads which was not significant in localizing ischemia. Outcome of CA showed CAD in majority and Triple Vessel Disease (TVD) was most common.