Percutaneous coronary revascularization plays an important role in the management of acute coronary syndrome. Unpredictable angiographic findings of anomalous coronary arteries may, however, compromise the otherwise high and predictable success rates of this intervention. We report a case of failed coronary angioplasty of the left anterior descending artery through an anomalous left main coronary artery originating from the right coronary sinus in a 33-year-old man with acute myocardial infarction complicated by cardiogenic shock. Subsequently the patient performed successful emergency coronary artery bypass graft.