Subjects most likely to require emer- gency CABG after failed PCI are those with evolving STEMI, cardiogenic shock, 3-vessel CAD, or the presence of a type C coronary arterial lesion (defined as 2 cm in length, an excessively tortuous proximal segment, an extremely angulated segment, a total occlusion 3 months in duration, or a degenerated SVG that appears to be In those in whom emergency CABG for failed PCI is performed, morbidity and mortality rates are increased com- pared with those undergoing elective CABG,287 289 resulting at least in part from the advanced age of many patients now referred for PCI, some of whom have multiple comorbid conditions and complex coronary anatomy. Several variables have been shown to be associated with increased periop- erative morbidity and mortality rates, including 1) de- multivessel CAD and complex lesion morphology,291,292 4) and 8) a prolonged time delay in transfer to the operating room.293 In patients undergoing emergency CABG for failed PCI, an off-pump procedure may be associated with a reduced incidence of renal failure, need for intra-aortic balloon use, and reoperation for bleeding.283,295 If complete revascularization is achieved with minimal delay in patients undergoing emergency CABG after failed PCI, long-term prognosis is similar to that of subjects undergoing elective CABG.280,282,296 In-hospital morbidity and mortality rates in women297 and the elderly298 undergoing emergency CABG for failed PCI are relatively high, but the long-term outcomes in these individuals are comparable to those achieved in men and younger patients. 2.2.4. CABG in Association With Other Cardiac Procedures: Recommendations Class I 1. CABG is recommended in patients undergoing non- coronary cardiac surgery with greater than or equal to 50% luminal diameter narrowing of the left main coronary artery or greater than or equal to 70% luminal diameter narrowing of other major coro- nary arteries. 