The utilization of stress echocardiography has undergone considerable expansion and evolution over the past three decades. Although stress echocardiography was first conceived as a noninvasive diagnostic tool for determining the presence or absence of coronary artery disease (CAD), its prognostic value is now well established. Thus, identification of patients at risk for future cardiac events has become a primary objective in the noninvasive evaluation of patients with chest pain syndromes and among patients with known CAD. In particular, the ability of stress echocardiography to identify patients at low (<1%), intermediate (1-5%) or high (>5%) risk for future cardiac events is essential to patient management decisions. Moreover, previous studies have conclusively demonstrated the incremental prognostic value of stress echocardiography over clinical and treadmill exercise data, in predicting future cardiac events. This review addresses the current role and summarizes current literature with respect to the use of stress echocardiography in determining patient risk for cardiac events and the cost-effective integration of such information into patient management decisions.