To assess the intermediate-term results of emergency coronary revascularization for acute myocardial infarction, we analyzed all patients (n = 35) who underwent coronary artery bypass grafting within 48 hr of acute myocardial infarction between January 1, 1982, and March 1, 1983. All patients had complete revascularization of infarct and noninfarct areas (3.4 +/- 1.65 distal anastomoses per patient). All patients have been traced as of February 21, 1984. Median duration of follow-up was 17.4 months (range 11.2 to 23.7). One in-hospital death (2.9%, 70% confidence limits 0% to 9%) occurred with low cardiac output, and no deaths occurred in the four patients who were in cardiogenic shock before surgery. One late death occurred from cancer, and 1 year overall actuarial survival is 94%. One patient underwent successful cardiac transplantation 8 months after operation. Ninety-seven percent of surviving patients are in NYHA class I or II, and 82% (27/33) have had no postoperative angina; six patients have mild angina. No patient has suffered a subsequent myocardial infarction. The early and intermediate results support continued application of emergency revascularization in higher-risk subsets of patients with acute myocardial infarction.