Acute myocardial infarction is an evolving event that lends itself well to surgical intervention. An historical review of surgery of acute myocardial infarction, with specific emphasis on the Spokane data, shows that this can be done safely and efficiently with myocardial salvage. Those people who were operated on within 6 hours of the onset of symptoms of acute myocardial infarction had a clear reduction in hospital mortality incidence and a better long-term result. The conclusion of our review is that emergency coronary artery bypass grafting for acute evolving myocardial infarction should be considered as a therapeutic option in every patient. All other modalities of therapy should be compared with the results of acute bypass surgery.