<![CDATA[Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Identifying early risk stratification before fatal clinical manifestations occur represents a major challenge in modern diagnostic cardiology. Although conventional cardiovascular risk scores and exercise stress testing (EST) are frequently used independently, the accuracy of validated risk scores in predicting physical stress-induced ischemia requires systematic evaluation. Purpose: To evaluate the discriminative ability of validated cardiovascular risk scores in predicting positive ischemic events during an exercise stress test (EST). Method: A systematic literature review (SLR) was conducted in accordance with the PRISMA framework. Articles published between 2020 and 2025 were retrieved from Scopus, ScienceDirect, and Google Scholar. Two reviewers independently extracted data using a standardized form. Study quality and bias were assessed with JBI Critical Appraisal Tools, and eligibility criteria were defined by the PICOS framework. The initial search yielded 174 articles, and 8 relevant studies were selected for narrative synthesis. Results: Validated cardiovascular risk scores show strong predictive value for ischemic outcomes on EST. Traditional risk factors (diabetes, hypertension, age, smoking) correlate with ECG ST‑segment depression, abnormal hemodynamics, and perfusion defects. High‑risk profiles also predict future MACE, even in patients with non‑ischemic stress test results. Conclusion: Cardiovascular risk scores enable effective early screening for ischemia in EST, optimizing referrals, interpretation, and cost‑effectiveness. Future work should develop composite scores integrating clinical and stress test parameters, and conduct longitudinal studies to establish long‑term prognostic value.]]>
