Single centers during the same time frame were able to achieve even more impressive results, with the University of Kentucky improving its -blocker use after CABG from 95% to 100% by implementing an intensive Finally, in a study exploring the Get With The Guidelines database, investigators noted that 90.8% of patients were discharged on -blocker therapy after Interestingly, this was less than comparable patients discharged after percutaneous coronary intervention. All of these studies were limited by their observational nature, and only 1 randomized trial of -blocker therapy after CABG has been performed. In 1995, Sjoland et al196 conducted a double-blind, placebo-controlled, randomized, controlled trial of 967 patients undergoing CABG. In this study, patients were randomized 4 to 21 days after CABG to 50 mg meto- prolol twice a day for 2 weeks and 100 mg metoprolol twice a day thereafter versus placebo for 2 years. The authors found no difference between the 2 arms of the trial with respect to the risk of death or the development of cardiac events, and there was no improvement in exercise capacity among the 618 patients who received an exercise test at follow-up. However, patients treated with placebo were found to have a higher (worse) chest pain score compared with patients treated with Contraindications to -blocker therapy can be particu- larly relevant in the post-CABG population because of the prevalence of reactive airway and pulmonary disease in these patients. However, the management of this comorbid condi- tion in the perioperative setting has improved substantially, and the specificity of 1 - and 2 -blockers has minimized the cross-reactivity between the cardiac and pulmonary effects of -blockade. 