Data on emergency coronary artery bypass surgery (CABG) are limited. We studied patients undergoing isolated CABG at Mayo Clinic between 1993 and 2019. Baseline characteristics and in-hospital outcomes of emergent CABG were described in consecutive eras (1993-2000, 2001-2010, 2011-2019). Cumulative survival was estimated by the Kaplan Meier method for the overall group, and stratified by the indication of surgery. Among the 14,455 isolated CABG included, 427 (2.95%) were emergent. The number of emergent CABG decreased from 222, to 150, and 55 in the consecutive study eras. There was a temporal increase in the prevalence of heart failure, but no change in mean age, and prevalence of hypertension, diabetes, renal failure, or atrial fibrillation. The proportion of patients with failed/complicated percutaneous coronary intervention decreased from 38.2% in 1993-2000 to 22.7% in 2001-2010 and 25.5% in 2011-2019 (p=0.003). In 2011-2019, 100% of patient received an internal mammary graft compared with 75.6% in 1993-2000 (P<0.001). Operative mortality was 8.7% overall (8.6% in 1993-2000, 10.0% in 2001-2010, and 5.5% in 2011-2019, p=0.56). There were no differences in post-operative complications except for the incidence of renal failure and new dialysis which increased over time. Predicted 10-year survival was 57.0% and was not different according to CABG indication (p=0.12). In conclusion, we documented a temporal decrease in the incidence of emergent CABG between 1993 and 2019, especially those performed due to complications of coronary interventions. Despite the higher prevalence of left ventricular dysfunction and the more complete revascularization in more recent years, in-hospital mortality did not increase.