BACKGROUND: Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis and risk-stratification of coronary artery disease, but no prognostic data have been reported from Southern Africa. OBJECTIVES: We investigated the prognostic utility of a South African DSE programme and compared the results to larger, internationals series. METHODS: All patients under going DSE from 2019 to 2023 at a single South African centre were included. A new wall motion abnormality (≥ 2 segments) signified inducible ischaemia. RESULTS: 166 patients (median age 65 ± 11years, 69% male) were analysed. 52 patients (31%) had diabetes mellitus, 155 (93%) had dyslipidaemia and 35 (21%) were smokers. 48 (29%) patients had received previous percutaneous revascularization and 10 (6%) coronary artery bypass surgery. During a median follow-up of 36 ± 7 months, 33 (20%) patients died or underwent coronary artery revascularization. Individuals with demonstrable, inducible ischaemia, experienced a higher rate of all-cause mortality or revascularization during follow-up. CONCLUSION: The prognostic value of a South African DSE programme for all-cause mortality and revascularization was demonstrated for the first time. Data are aligned with large, international series with comparable follow-up time.