Daubert MA, Sivak J, Dunning A, et al. - In order to ascertain whether individuals with +ECG/−Echo have a higher rate of adverse clinical events and a poorer prognosis than individuals with negative exercise ECG and normal stress Echo imaging (−ECG/−Echo), researchers performed an observational cohort study including a sum of 47,944 consecutive individuals without known coronary artery disease who underwent exercise stress Echo at Duke University Medical Center between January 1, 2000, and February 28, 2014. Data analysis was carried between January 1, 2000, and December 31, 2016. Individuals were divided into −ECG/−Echo, +ECG/−Echo, or +Echo (−ECG/+Echo and +ECG/+Echo). The primary outcomes included a composite endpoint of death, myocardial infarction, hospitalization for unstable angina, and coronary revascularization. Secondary outcomes were individual adverse events and downstream testing. The appearance of +ECG outcomes with normal stress Echo imaging may distinguish a population of individuals who are at slightly increased risk for adverse cardiac events, which was not previously identified. Future research is required to ascertain whether these individuals will benefit from the intensification of medical management.