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There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment–elevation myocardial infarction (STEMI) patients in contemporary practice.Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%–7.8%; P value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0–70.3 hours) in CABG only, 49.7 hours (IQR, 3.2–70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7–96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28–40 versus median, 32; IQR, 27–38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG.CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.