A databank search was performed and 148 consecutive patients (mean age 59.5 +/- 10.4 years) were identified who underwent emergency coronary artery bypass surgery at the Mayo Clinic between November 20, 1979, and February 12, 1992, immediately after unsuccessful coronary angioplasty. At the end of the angioplasty procedure, there was no anterograde coronary blood flow in the treated artery in 54%, ongoing chest pain in 78%, and hemodynamic compromise requiring intravenous vasopressor therapy in 25% of patients; 127 patients (86%) had at least 1 of these adverse characteristics. After leaving the catheterization laboratory, the median time to arrival in the operating room was 12 minutes. Median time from arrival in the operating room to initiation of cardiopulmonary bypass was 86 minutes, to administration of cardioplegia was 98 minutes, and to removal of the aortic cross-clamp was 135 minutes. In-hospital mortality was 11%, and 18% developed nonfatal Q-wave myocardial infarction. Thus, significant time is required to achieve surgical reperfusion after unsuccessful coronary angioplasty.