Comparison of the immediate results after off-pump and on-pump coronary artery bypass grafting in patients with acute coronary syndromes

Authors: Zhalilov A.K., Merzlyakov V.Yu., Klyuchnikov I.V., Salomov M.A., Khaziev R.A., Berdibekov B.Sh.

Company: 1Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
2 Republican Specialized Scientific and Practical Medical Center of Cardiology. Karshi Branch in Karshi, Uzbekistan

For correspondence:  Sign in or register.

Type:  Original articles


For citation: Zhalilov A.K., Merzlyakov V.Yu., Klyuchnikov I.V., Salomov M.A., Khaziev R.A., Berdibekov B.Sh. Comparison of the immediate results after off-pump and on-pump coronary artery bypass grafting in patients with acute coronary syndromes. Creative Cardiology. 2023; 17 (2): 256–71 (in Russ.). DOI: 10.24022/1997-3187-2023-17-2-256-27

Received / Accepted:  02.05.2023 / 22.05.2023

Keywords: coronary artery bypass grafting acute coronary syndrome myocardial infarction off-pump coronary artery bypass

Subscribe 🔒



Objective. To study the efficacy, safety, and short-term results after off-pump (OPCAB) and conventional onpump coronary artery bypass (ONCAB) in patients with acute coronary syndrome (ACS).

Material and methods. We retrospectively analyzed a consecutive series of 187 patients who underwent CCAB and 220 patients who underwent OPCAB for ACS. The average age of the patients was 59.8±7.9 years, mainly men 204 (83.6%). Propensity score matching (1:1) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 262 matched patients with ACS. The primary outcome was in-hospital mortality, repeated myocardial revascularization, myocardial infarction (MI), postoperative cerebrovascular accidents (stroke, transient ischemic attack (TIA)), as well as a composite outcome of in-hospital mortality, repeated myocardial revascularization, MI, and postoperative cerebrovascular accidents.

Results. There was no significant difference between off-pump and on-pump coronary artery bypass grafting (CABG) in the rate of in-hospital mortality (2.3% and 3.1%, respectively; p=1.00), perioperative stroke (0.8% and 3.8%, respectively; p=0.21), TIA (1.5% and 0.8%, respectively; p=1.00), MI (3.1% and 6.2%, respectively; p=0.25), and repeated myocardial revascularization (0.8% and 0.8%, respectively; p=1.00). However, the rate of the composite outcome was higher for on-pump than for off-pump CABG (13.0 vs. 5.3%, p=0.03). In multivariate regression analysis, age (odds ratio (OR) 1.07; 95% confidence interval (CI) (1.01–1.13); p=0.03), Logistic EuroSCORE II (OR 1.21; 95% (CI (1.02–1.42); p=0.02), and OPCAB (OR 0.34; 95% CI (0.13–0.90); p=0.03) demonstrated an independent association with the composite outcome. Furthermore, 67.9% of patients in the OPCAB group and 77.9% in the CCAB group underwent intraoperative shuntography, which revealed mechanical complications of the shunt in 15 (11.5%) and 11 (8.4%) cases, respectively (p=0.408).

Conclusion. This study provided further evidence on the safety and efficacy of OPCAB in the treatment of patients with ACS who underwent CABG.


  1. Keeley E.C., Hillis L.D. Primary PCI for myocardial infarction with ST-segment elevation. N. Engl. J. Med. 2007; 356 (1): 47–54. DOI: 10.1056/NEJMct063503
  2. Khoroshikh L.V., Khotsanyan C., Gromova O.I., Bulaeva N.I. Prognostic value of myocardial injury marker (stimulating growth factor ST2) in patients with acute coronary syndrome. Creative Cardiology. 2021; 15 (4): 468–81 (in Russ.). DOI: 10.24022/1997-3187-2021-15-4-468-481
  3. Neumann F.J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019; 40 (2): 87–165. DOI: 10.1093/eurheartj/ehy394
  4. Collet J.P., Thiele H., Barbato E., Barthélémy O., Bauersachs J., Bhatt D.L. et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2021; 42 (14): 1289–367. DOI: 10.1093/eurheartj/ehaa575
  5. Ranasinghe I., Alprandi-Costa B., Chow V., Elliott J.M., Waites J., Counsell J. T. et al. Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999–2007. Am. J. Cardiol. 2011; 108 (5): 617–24. DOI: 10.1016/j.amjcard.2011.04.005
  6. Kudryashova E.N., Berdibekov B.Sh., Bulaeva N.I., Golukhova E.Z. The choice of revascularization method in patients with stable coronary artery disease and diabetes mellitus. Creative Cardiology. 2021; 15 (1): 61–71 (in Russ.). DOI: 10.24022/1997-3187-2021-15-1-61-71
  7. Chang M., Lee C.W., Ahn J.M., Cavalcante R., Sotomi Y., Onuma Y. et al. Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-STElevation Acute Coronary Syndrome. Am. J. Cardiol. 2017; 120 (3): 380–6. DOI: 10.1016/j.amjcard.2017.04.038.
  8. Fudulu D., Benedetto U., Pecchinenda G.G., Chivasso P., Bruno V.D., Rapetto F. et al. Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials. J. Thorac. Dis. 2016; 8 (Suppl. 10): S758–71. DOI: 10.21037/jtd.2016.10.80
  9. Moscarelli M., Harling L., Ashrafian H., Athanasiou T. Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome? Interact. Cardiovasc. Thorac. Surg. 2013; 16 (3): 350–5. DOI: 10.1093/icvts/ivs476
  10. Neumann A., Serna-Higuita L., Detzel H., Popov A.F., Krüger T., Vöhringer L. et al. Off-pump coronary artery bypass grafting for patients with severely reduced ventricular function – A justified strategy? J. Card. Surg. 2022; 37 (1): 7–17. DOI: 10.1111/jocs.15259
  11. Melikulov A.A., Merzlyakov V.Yu., Klyuchnikov I.V., Skopin A.I., Darvisch N.A., Mamedova S.K. et al. The immediate results of coronary artery bypass grafting, depending on revascularization at simultaneous interventions on brachiocephalic arteries. Creative Cardiology. 2017; 11 (4): 304–14 (in Russ.). DOI: 10.24022/1997-3187-2017-11-4-304-314
  12. Golukhova E.Z. Myocardial revascularization: new randomized trials with controversial results. Creative Cardiology. 2016; 10 (4): 276–80 (in Russ.). DOI: 10.15275/kreatkard.2016.04.01
  13. Fukui T., Tabata M., Morita S., Takanashi S. Early and long-term outcomes of coronary artery bypass grafting in patients with acute coronary syndrome versus stable angina pectoris. J. Thorac. Cardiovasc. Surg. 2013; 145 (6): 1577–83e1. DOI: 10.1016/j.jtcvs.2012.05.043
  14. Neumann A., Vöhringer L., Fischer J., Mustafi M., Schneider W., Krüger T. et al. Off-pump coronary artery bypass grafting in acute coronary syndrome: focus on safety and completeness of revascularization. Thorac. Cardiovasc. Surg. 2020; 68 (8): 679–86. DOI: 10.1055/s-0039-1677834 15. Ben-Gal Y., Stone G.W., Smith C.R., Williams M.R., Weisz G., Stewart A.S. et al. On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. J. Thorac. Cardiovasc. Surg. 2011; 142 (2): e33–9. DOI: 10.1016/j.jtcvs.2011.03.022
  15. Hwang B., Williams M.L., Tian D.H., Yan T.D., Misfeld M. Coronary artery bypass surgery for acute coronary syndrome: a network meta-analysis of on-pump cardioplegic arrest, offpump, and on-pump beating heart strategies. J. Card. Surg. 2022; 37 (12): 5290–9. DOI: 10.1111/jocs.17149
  16. Lamy A., Devereaux P.J., Prabhakaran D., Taggart D.P., Hu S., Straka Z. et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N. Engl. J. Med. 2016; 375 (24): 2359–68. DOI: 10.1056/NEJMoa1601564

About Authors

  • Adkham K. Zhalilov, Cand. Med. Sc., Applicant of Bakoulev NMRC CS, Cardiac Surgeon, Head of Department of RSS PMCC, Karshi Branch; ORCID
  • Vadim Yu. Merzlyakov, Dr. Med. Sci., Head of Department, Cardiac Surgeon; ORCID
  • Ivan V. Klyuchnikov, Dr. Med. Sci., Professor, Chief Researcher, Cardiologist; ORCID
  • Makhmadsharif A. Salomov, Researcher, Cardiac Surgeon; ORCID
  • Ruslan A. Khaziev, Cardiac Surgeon; ORCID
  • Bektur Sh. Berdibekov, Researcher, Cardiologist; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery