This longitudinal, obser- vational registry study demonstrated that the use of -blocker therapy was not associated with a lower risk of cardiovascular events, including cardiovascular death, nonfatal MI, or non- fatal stroke, whether patients had risk factors only, a known prior MI, or known CAD without MI.199 Many patients under- going CABG would likely fall into one of these categories. However, it is not yet clear how this information should be directly applied to the postoperative patient because many CABG patients have additional clinical conditions that war- rant -blocker therapy after surgery, including hypertension and AF. Because AF continues to occur at a high rate after -blocker therapy remains the mainstay of both AF prevention and rate control through its 1 -adrenergic A meta-analysis of contemporary clinical trials illustrated a 50% reduction in the risk of postoperative AF with prophylactic -blocker therapy.202 Moreover, many patients on preoperative -blocker therapy have rebound tachycardia if -blocker therapy is not resumed early in the postoperative period. The role of -blocker therapy in the perioperative period remains controversial. A substantial percentage of patients undergoing CABG receive preoperative -blocker therapy because it has been demonstrated to convey a mortality ben- Consequently, preoperative -blocker therapy was determined to be a quality metric for cardiac surgery by the National Quality Forum and was included in the Society of Thoracic Surgeons Composite Score for CABG Quality pro- However, other more recent studies have questioned whether preoperative -blocker therapy actually affects mor- It is possible that the outcomes from surgical revas- cularization have improved to the point where a benefit from preoperative -blocker therapy can no longer meet the thresh- old of statistical significance.204 Nevertheless, continuation of preoperative -blockade therapy into the postoperative period remains an important consideration. 