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Introduction Exercise Stress Testing (EST) is a well-established screening tool for CAD with reported mean sensitivity of 67- 68 % and specificity of 72- 77 %. In recent years, Computer Tomography Coronary Angiogram (CTCA) had largely replaced EST as preferred screening test due to better sensitivity(98–99%) and specificity(82–89%) with positive predictive value(PPV) and negative predictive value(NPV) of 85% and 92%, respectively. However, CTCA is less accessible due to cost and resources.Methods We performed a retrospective review of patients referred to Mercy University Hospital(MUH) for EST from Jan 2022-July 2024 who had either CTCA or Invasive Coronary Angiogram(ICA) to confirm the presence of significant CAD defined by stenosis>50%. 1107 patients completed EST comprising 723 Males and 384 Females aged 14–88 years old with a mean of 59.3 years old.Results 822/1107 (74.3%) patients had negative EST, 137/1107 (12.4%) had positive EST. 61/1107 (5.51%) patients had Equivocal results and 87/1107 (7.85%) patients had Inconclusive or Submaximal results. (figure 1) 62/822 (7.54%) with negative EST and 94/137 (68.6%) with positive EST had subsequent investigation for CAD by either CTCA or ICA. (figure 2) 53/94 (56.3%) patients with positive EST were true positives and 41/94 (43.6%) were false positive. 41/62 (66.1%) patients with negative EST who had available follow up were true negative and 21/62 (33.9%) were false negative. (table 1).Conclusions/Implications Our experience in EST demonstrated 71.6 % sensitivity in detecting significant CAD. Our low specificity (50.0%) result is subjected to verification bias. In fact, 342/822 (41.6%) patients with negative results are discharged from Cardiology services if they have no high risk features.EST remains a reliable, low cost screening test for CAD. It is suitable for patients with low pretest probability and able to alleviate long waiting lists for CTCA.Abstract 90 Table 1Confusion matrix: EST results & presence of CADAbstract 90 Figure 1EST resultsAbstract 90 Figure 2Referrals for further investigations