Background <p>Surgical urgency in minimally invasive coronary artery bypass grafting (MICS-CABG) is associated with increased perioperative risk. This study evaluates the impact of surgical urgency on early postoperative outcomes in patients undergoing isolated MICS-CABG.</p> Methods <p>A retrospective cohort study was conducted at Shar Hospital, Erbil, Iraq, including 311 patients who underwent isolated MICS-CABG between September 2021 and December 2024. Patients were classified as elective group (<i>n</i> = 285) and urgent group (<i>n</i> = 26) according to Society of Thoracic Surgeons criteria. Baseline demographics, intraoperative variables, and early postoperative outcomes were compared using appropriate statistical tests with a significance level of <i>p</i> &lt; 0.05.</p> Results <p>Baseline characteristics, including, gender, and body mass index, showed no significant differences between elective and urgent groups. However, the urgent group had significantly lower preoperative left ventricular ejection fraction (49.2% ± 12.0 vs. 53.8% ± 10.0, <i>p</i> = 0.032) and higher preoperative serum creatinine levels (1.59 ± 1.58 vs. 1.19 ± 1.94&#xa0;mg/dL, <i>p</i> = 0.008). Intraoperatively, urgent patients required more vasopressor support (adrenaline: 26.9% vs. 10.2%, <i>p</i> = 0.020; noradrenaline: 73.1% vs. 40.7%, <i>p</i> = 0.001). Postoperatively, urgent cases had higher serum creatinine (1.86 ± 1.79 vs. 1.14 ± 0.58&#xa0;mg/dL, <i>p</i> = 0.037) and more frequent incidence of acute respiratory failure in urgent group (39.1% vs. 17.5%, <i>p</i> = 0.023).</p> Conclusions <p>Urgent MICS-CABG was associated with increased vasopressor use, renal dysfunction, and respiratory complications.</p> Trial registration <p>Not applicable.</p>