Background: Diagnosis of chronic coronary syndrome is challenging. The role of exercise electrocardiography (ECG) decreased because of many artifacts and low diagnostic accuracy. Therefore, non-invasive stress imaging is the current approved recommendation for diagnosis of chronic coronary syndrome in patients with clinical pre-test probability of more than 15% or 5-15% with high clinical likelihood. Dobutamine echocardiography (Echo) is widely available but with limitations. Therefore, combined dobutamine Echo and ECG could improve the diagnostic accuracy. Methods: We performed a cross sectional study in Zagazig university hospitals in the period between April 2023 and October 2023. We included all patients with suspected chronic coronary syndrome with clinical pre-test probability more than 5%. All patients underwent combined dobutamine Echo and ECG and invasive coronary angiography. Diagnostic accuracy of combined dobutamine Echo and ECG was compared with dobutamine Echo. Results: Among 50 patients suspected chronic coronary syndrome, 37 patients had significant coronary artery disease (CAD) in invasive coronary angiography. As compared with dobutamine Echo, combined Echo and ECG had more favorable sensitivity (97.1% vs 93.5%) and specificity (75% vs 57.9%) for prediction of significant CAD. Conclusions: With better diagnostic accuracy, combined dobutamine Echo and ECG is simple, cheap, and available non-invasive test for diagnosis of chronic coronary syndrome.