Emergency CABG is recommended after failed PCI for hemodynamic compromise in patients without impairment of the coagulation system and without a previous sternotomy.280,282,283 (Level of Evidence: B) Class IIa 1. Emergency CABG is reasonable after failed PCI for retrieval of a foreign body (most likely a fractured guidewire or stent) in a crucial anatomic location. (Level of Evidence: C) 2. Emergency CABG can be beneficial after failed PCI for hemodynamic compromise in patients with im- pairment of the coagulation system and without previous sternotomy. (Level of Evidence: C) Class IIb 1. Emergency CABG might be considered after failed PCI for hemodynamic compromise in patients with previous sternotomy. (Level of Evidence: C) Class III: HARM 1. Emergency CABG should not be performed after failed PCI in the absence of ischemia or threatened occlusion. (Level of Evidence: C) 2. Emergency CABG should not be performed after failed PCI if revascularization is impossible because of target anatomy or a no-reflow state. (Level of Evidence: C) See Online Data Supplement 7 for additional data on CABG after failed PCI. With widespread stent use as well as effective antiplate- let and antithrombotic therapies, emergency CABG after failed PCI is not commonly performed. In a 2009 analysis of data from almost 22 000 patients undergoing PCI at a single center, only 90 (0.4%) required CABG within 24 hours of PCI.281 A similarly low rate ( 0.8%) of emer- gency CABG after PCI has been reported by others.284 286 The indications for emergency CABG after PCI include 1) acute (or threatened) vessel closure, 2) coronary arterial dissection, 3) coronary arterial perforation,281 and 4) mal- function of PCI equipment (eg, stent dislodgement, frac- tured guidewire). 