-Blockers are competitive antago- nists at the -adrenergic receptors, thus modulating activities in this pathway. Although most of the pharmacological effects are attributed to this receptor blockade, some -blockers are relatively selective for the 1 -adrenergic receptor, others are nonselective, and still others have intrinsic sympathomimetic activity, -adrenergic receptor blockade, and direct vasodilat- Data to support the use of -blocker therapy in ischemic heart disease date back to the early 1980s, when randomized trial data were first generated evaluating the use of -blocker therapy in patients with acute MI.188 At that time, it was not uncommon for CABG operations to be postponed if patients were treated with -blocker therapy (ie, propranolol) because of the presumption of increased risk of surgical mortality. This sentiment undoubtedly contributed to the lower use of -blocker therapy at discharge among MI patients undergo- ing CABG compared with those treated with medical ther- Subsequently, Chen et al189 noted in a cohort study that -blocker therapy was just as effective in reducing 1-year mortality for patients undergoing revascularization as it was for patients not undergoing revascularization. In the Chen et al189 study, 33.1% of patients undergo- ing CABG in 1994 to 1995 were not prescribed -blocker therapy at discharge. Thereafter, in 2002, Ferguson and col- raised awareness of the importance of -blocker Kulik et al Secondary Prevention After CABG 937 therapy among CABG patients by documenting an association between preoperative -blocker therapy and improved 30-day mortality. Evaluating the outcomes of >600000 CABG patients in the Society of Thoracic Surgeons Database from 1996 to 1999, these authors noted that patients who received -blockers before surgery had significantly lower 30-day mor- tality rates compared with those who did not (adjusted OR, 0.94; 95% CI, 0.91 0.97). 