{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:00Z","timestamp":1788243360079,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The comparative efficacy of off-pump and on-pump coronary bypass grafting (CABG) for patients with acute and subacute myocardial infarction (AMI) remains controversial. We compared the outcomes of on-pump versus off-pump coronary artery bypass grafting in Korean patients with acute and subacute myocardial infarction. Methods: This nationwide retrospective cohort study included 14,578 propensity score-matched patients undergoing on-pump or off-pump CABG between 2007 and 2022 using the Korean National Health Insurance Service database. The primary outcomes were recurrent myocardial infarction, repeat revascularization, stroke, all-cause mortality, and major adverse cardiovascular and cerebrovascular events. Chi-square, Kaplan\u2013Meier, and log-rank tests and Cox regression analysis were used. Results: Compared with on-pump CABG, off-pump CABG was associated with significantly lower risks of major adverse cardiovascular and cerebrovascular events (MACCEs), all-cause mortality, and recurrent myocardial infarction in the cause-specific Cox analysis, whereas repeat revascularization and stroke rates were comparable between groups. However, the association with recurrent myocardial infarction was not statistically significant in the Fine\u2013Gray competing-risk analysis. Conclusions: Off-pump CABG was associated with lower risks of all-cause mortality and MACCEs in patients with acute and subacute myocardial infarction. The association with recurrent myocardial infarction was less consistent across analytical approaches and should be interpreted cautiously.<\/jats:p>","DOI":"10.3390\/jcm15176707","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting for Acute and Subacute Myocardial Infarction: A Nationwide Propensity Score-Matched Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1608-9674","authenticated-orcid":false,"given":"Hyo-Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Thoracic & Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4947-3250","authenticated-orcid":false,"given":"Jiyoung","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Thoracic & Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Kang Ju","family":"Son","sequence":"additional","affiliation":[{"name":"Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6845-6310","authenticated-orcid":false,"given":"Kyung-Jong","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1498-4111","authenticated-orcid":false,"given":"Young-Nam","family":"Youn","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","unstructured":"Health Insurance Review & Assessment Service (2025, July 27). Results of the 6th Adequacy Evaluation of Coronary Artery Bypass Surgery, National Health Insurance Review and Assessment Health Service. Available online: https:\/\/aq.hira.or.kr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1056\/NEJMoa1808788","article-title":"One-year outcomes after PCI strategies in cardiogenic shock","volume":"379","author":"Thiele","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s13054-014-0516-y","article-title":"Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: A landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry","volume":"18","author":"Aissaoui","year":"2014","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jtcvs.2015.08.042","article-title":"Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis","volume":"151","author":"Kowalewski","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.jtcvs.2015.11.023","article-title":"Off-pump versus on-pump coronary artery bypass grafting in patients with left ventricular dysfunction","volume":"151","author":"Ueki","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jtcvs.2011.11.011","article-title":"On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study)","volume":"143","author":"Lemma","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1056\/NEJMoa1601564","article-title":"Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting","volume":"375","author":"Lamy","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1056\/NEJMoa1614341","article-title":"Five-year outcomes after on-pump and off-pump coronary-artery bypass","volume":"377","author":"Shroyer","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1056\/NEJMoa1211666","article-title":"Off-pump versus on-pump coronary-artery bypass grafting in elderly patients","volume":"368","author":"Diegeler","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"106165","DOI":"10.1016\/j.ijsu.2021.106165","article-title":"Strocss 2021: Strengthening the reporting of cohort across-sectional and case-control studies in surgery","volume":"96","author":"Mathew","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1056\/NEJMoa0902905","article-title":"On-pump versus off-pump coronary-artery bypass surgery","volume":"361","author":"Shroyer","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1056\/NEJMoa1200388","article-title":"Off-pump or on-pump coronary-artery bypass grafting at 30 days","volume":"366","author":"Lamy","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1161\/CIRCULATIONAHA.106.675595","article-title":"Off-pump versus on-pump coronary artery bypass graft surgery: Differences in short-term outcomes and in long-term mortality and need for subsequent revascularization","volume":"116","author":"Hannan","year":"2007","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4263","DOI":"10.1097\/JS9.0000000000000715","article-title":"Comparative efficacy on outcomes of C-CABG, OPCAB, and ONBEAT in coronary heart disease: A systematic review and network meta-analysis of randomized controlled trials","volume":"109","author":"Zhu","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.athoracsur.2021.07.035","article-title":"Real-world outcomes of on- vs off-pump coronary bypass surgery: Result from Korean nationwide cohort","volume":"113","author":"Park","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1016\/j.amjcard.2017.08.007","article-title":"Meta-analysis comparing \u226510-year mortality of off-pump versus on-pump coronary artery bypass grafting","volume":"120","author":"Takagi","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1053\/j.jvca.2018.04.012","article-title":"Off-pump versus on-pump coronary artery bypass grafting-a systematic review and analysis of clinical outcomes","volume":"33","author":"Shaefi","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jtcvs.2006.03.027","article-title":"An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response","volume":"132","author":"Shann","year":"2006","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1213\/01.ANE.0000220035.82989.79","article-title":"Cardiopulmonary bypass management and neurologic outcomes: An evidence-based appraisal of current practices","volume":"103","author":"Hogue","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1055\/s-0038-1651516","article-title":"Current status of off-pump coronary artery bypass grafting in patients with multiple coronary artery disease compared with on-pump coronary artery bypass grafting: The Korean National Cohort Study","volume":"66","author":"Kim","year":"2018","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"518","DOI":"10.4070\/kcj.2020.0443","article-title":"Hospital case volume, health care providers, and mortality in patients undergoing coronary artery bypass grafting: A nationwide cohort study in South Korea","volume":"51","author":"Oh","year":"2021","journal-title":"Korean Circ. J."},{"key":"ref_23","unstructured":"Korea Disease Control and Prevention Agency (2025, July 27). 2022 Korean National Cardio-Cerebrovascular Disease Statistics, Available online: www.kdca.go.kr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6707\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:53:21Z","timestamp":1788242001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":23,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176707"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176707","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]}}}