Emergency operations for restoration of coronary artery blood flow are an effective means for treatment of unstable anginal syndromes. The risk of such operations is minimized by preoperative stabilization with medical therapy. Mechanical circulatory assistance may be a useful adjunct in some patients, especially in the presence of left main coronary obstruction. Utilization of emergency revascularization for patients with evolving myocardial infarction may be beneficial in some patients, but this approach remains controversial at present. Emergency revascularization for cardiogenic shock improves chances for survival in selected patients, and it may be combined with valve replacement, infarct resection, or repair of ruptured myocardium in patients with adequate residual contractile tissue.