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Revascularization is standard therapy for patients who present with acute myocardial infarction. Coronary artery bypass graft surgery remains a critical option for revascularization specifically in patients with acute myocardial infarction. Certain clinical or patient factors should help in deciding whether coronary artery bypass graft surgery is appropriate for an individual case as supported by international guidelines. Where coronary artery bypass graft surgery is indicated, perioperative management of the patient should be optimized to ensure the best outcomes while minimizing risk. This chapter discusses the surgical management of patients with acute myocardial infarction, specifically, perioperative management and indications for revascularization.