Percutaneous transluminal coronary recanalization (PTCR) was carried out in 201 patients with acute myocardial infarction. Fifteen patients required emergency aorto-coronary bypass grafting (ACBG) subsequent to PTCR; in one immediately following unsuccessful thrombolysis and the remaining 14 patients within 10 days after initial successful recanalization because of reinfarction. One patient died of multiorgan failure postoperatively. Excluding one patient, all patients had left main trunk disease (LMTD) and/or 3 vessel disease (3VD), with residual stenosis at the site of recanalization of greater than 99% with filling delay. Nonsurviving without surgery and medically managed patients on whom repeated angiography was carried out also analysed, in an effort to establish angiographic indications for supplementary surgical revascularization. Patients having extensive coronary artery disease such as LMTD and/or 3VD, emergency ACBG should be performed immediately following PTCR, if the remaining causative stenosis is greater than 99% with filing delay.