The urgent coronary surgery performed in patients with high risk unstable angina (rest pain greater than 48 h) shows still different results. We found in 57 urgent operated patients the same functional and clinical results as after elective bypass grafting. A higher in hospital mortality after urgent coronary surgery based on a higher number of grafts are occluded in the early postoperative period. The better prognosis concluded that the use of urgent coronary surgery is the therapy of choice in patients with refractory unstable angina pectoris.