=Abstract= Background: Failed percutaneous coronary angioplasty (PTCA) is occasionally required emergency coronary artery bypass grafting.(CABG) The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA in Severance hospital over a 17-year period. Methods: From May 1988 through May 2005, 27 patients underwent emergency CABG after failed PTCA. Patients were divided into two cohorts based on the date of the PTCA: 1988 to 1998(n=18) (group1) and 1999 to 2005(n=9) (group2). We compared with preoperative characteristics and postoperative clinical outcomes between two groups. Mean age was 63(50-80) years, and 14 patients were male (52%). Preoperative clinical diagnosis for coronary artery disease included acute myocardial infarction (MI) (12), unstable angina (13), and stable angina (2). Results: All patients required emergent surgical revascularization within 24 hours. 22 patients underwent conventional CABG and 5 patients underwent off-pump CABG. Mean operation time, CPB time and ACC time were 307.92짹83.16, 131.9짹54.84, 73.15짹32.29 minutes respectively. Mean number of distal graft was 2.58짹0.95. Group 2 patients tended to be more used arterial graft (11.1% vs 88.9% p<0.05). There was significant deference in the incidence of postoperative myocardial infarction using enzyme and electrocardiographic criteria (16.7% in group 1 vs. 0% in group 2), 30-day operative mortality after emergent operation was 22.2%(4/18) in group 1 and 0%(0/9) in group 2. But there was no significant difference in the incidence of postoperative complications (44.4% in group 1 and 55.5% in group 2). Mean follow up duration was 43.07짹61.15 months. Conclusion: With prompt, aggressive, use of arterial graft and complete myocardial revascularization, patients who required emergency CABG after failed PTCA can decrease the risk for postoperative complications and deaths.