While, initially, emergency revascularization was expected to improve significantly the poor outlook in unstable angina, simultaneous advances in medical management led to controversial reports on the results of medical versus surgical therapy. Controlled randomized studies, especially the National Heart, Lung and Blood Institute Trial from 1972 to 1976, led to the conclusion that there is no evidence that emergency revascularization is superior to vigorous medical treatment. This conclusion is not universally accepted because surgical and anesthetic methodology has since been further developed, especially with the use of cardioplegia and intraaortic balloon-pumping. Our own results appear to confirm that patients with unstable angina can undergo surgery without elevated mortality, but that non-fatal perioperative infarction still occurs somewhat more frequently than in stable cases.