This retrospective analysis assessed the efficacy of intravenous landiolol hydrochloride as premedication for contrast-enhanced coronary CT angiography (CCTA). A total of 37 patients with heart rates >60 bpm received a bolus of landiolol hydrochloride to achieve optimal heart rate control before CCTA. The medication was administered incrementally until the heart rate fell to 60 bpm or lower or up to a maximum dose of 60 mg. The results demonstrated that a stepwise injection of landiolol hydrochloride (up to 40 mg) effectively reduced heart rate by an average of 14 bpm in patients who had not received oral beta-blocker premedication, and by 5 bpm in those who had. A significant proportion of patients achieved heart rates of ≤65 bpm, highlighting the efficacy of landiolol hydrochloride in optimizing conditions for CCTA.