Objective: To determine the utility of exercise electrocardiography testing (EET) in evaluating suspected coronary artery disease in a remote Australian setting where a significant proportion of patients are Indigenous Australians. Design: Retrospective cohort study with grouping based on EET results. Patients and setting: 268 patients with suspected coronary artery disease who underwent EET at Alice Springs Hospital - a specialist teaching hospital in Central Australia with no resident specialist cardiology service - in the period 1 June 2009 to 31 May 2010. Main outcome measures: Diagnosis of coronary artery disease, based on coronary angiography and/or admission with acute coronary syndrome, in the 24 months after EET. Results: Indigenous patients were younger, more likely to be women and were twice as likely as non-Indigenous patients to have a chronic disease. Indigenous patients and those with a chronic disease had a higher proportion of inconclusive results. Completed EET had a positive predictive value of 48.1% (95% CI, 28.7%-68.1%) and a negative predictive value of 96.5% (95% CI, 93.2%-98.5%). Similar results were seen among Indigenous and non-Indigenous patients. Conclusions: In regional and remote Australian settings, EET remains an important tool for the diagnosis of coronary artery disease. It is useful, and is reassuring to patients and clinicians if the result is negative, particularly in a remote Indigenous Australian population with a significant burden of I Cardiovascular risk.