Comparison of Changes in Cardiac Biochemical Markers between Off- pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease

Abstract

Background: Coronary artery bypass grafting is a key revascularization option for multivessel coronary artery disease. Off-pump CABG avoids cardiopulmonary bypass–related complications, yet concerns remain about myocardial injury. Cardiac biochemical markers offer an objective assessment of myocardial damage across surgical techniques. Objective: To compare perioperative changes in cardiac biochemical markers between on- pump and off-pump CABG procedures in patients with multivessel coronary artery disease. Methods: This comparative cross-sectional study was conducted at the NICVD from June 2021 to May 2023. A total of 60 patients with angiographically confirmed multivessel coronary artery disease were enrolled using convenience sampling and equally divided into Group A (OPCAB) and Group B (on-pump CABG). Postoperative venous blood samples were obtained at predefined intervals; CK-MB, troponin I, and NT-proBNP were analyzed using SPSS v27. Results: The mean age was similar in Group A (56.83 ±5.54 years) and Group B (57.87 ±4.95 years), with male predominance in both. Baseline comorbidities, left ventricular ejection fraction, and coronary angiographic profiles showed no significant differences. Inotropic support was required more frequently in the on-pump group (88.5% vs. 11.5%, p<0.001). Postoperative CK-MB, cTnI, and NT-proBNP levels were significantly higher in the on-pump group at 6, 12, and 24 hours, but became comparable beyond 24 hours. Conclusion: On-pump CABG showed greater postoperative cardiac biomarker elevation, suggesting increased myocardial injury, whereas OPCAB provided better myocardial protection and may be a preferable option in selected multivessel coronary artery disease patients.