The authors describe the case of a patient who was admitted for four-hour lasting acute myocardial infarction of the anterior wall with elevations of ST segments on ECG. The finding obtained in selective coronarography revealed an unsuitable condition for coronary intervention (a narrow stenosis of the stem, RIA occlusion, further two narrow stenoses in the coronary vascular bed). Since an operation room was not available at the moment the patient was indicated for palliative PTCA RIA (prevention of necrosis evolution) and subsequent urgent complete surgical revascularization of myocardium. The uncomplicated post-operation course and returned function of the affected myocardium indicates that the intervention may be considered as a suitable alternative for the treatment of acute myocardial infarction.

        Key words: urgent surgical revascularization of myocardium – primary transluminal coronary angioplasty – stenosis of the stern of the left coronary artery – acute myocardial infarction