Emergency CABG is recommended in patients with cardiogenic shock and who are suitable for CABG irrespective of the time interval from MI to onset of shock and time from MI to CABG.238,245 247 (Level of Evidence: B) 4. Emergency CABG is recommended in patients with life-threatening ventricular arrhythmias (believed to be ischemic in origin) in the presence of left main stenosis greater than or equal to 50% and/or 3-vessel CAD.248 (Level of Evidence: C) Class IIa 1. The use of CABG is reasonable as a revasculariza- tion strategy in patients with multivessel CAD with recurrent angina or MI within the first 48 hours of STEMI presentation as an alternative to a more delayed strategy.235,237,239,249 (Level of Evidence: B) 2. Early revascularization with PCI or CABG is rea- sonable for selected patients greater than 75 years of age with ST-segment elevation or left bundle branch block who are suitable for revascularization irre- spective of the time interval from MI to onset of shock.250 254 (Level of Evidence: B) Class III: HARM 1. Emergency CABG should not be performed in pa- tients with persistent angina and a small area of viable myocardium who are stable hemodynam- ically. (Level of Evidence: C) 2. Emergency CABG should not be performed in pa- tients with noreflow (successful epicardial reperfu- sion with unsuccessful microvascular reperfusion). (Level of Evidence: C) See Online Data Supplement 5 for additional data on CABG in patients with acute myocardial infarction. 