Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring heart-type fatty-acid-binding protein release
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Updated: Jul 19, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Vishwas Malik1, Shailaja C Kale, Ujjwal K Chowdhury
1Department of Cardiac Anesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Insights
Off-pump coronary artery bypass grafting (CABG) causes less myocardial injury than on-pump CABG, as indicated by lower heart-type fatty-acid-binding protein (hFABP) and creatine kinase-MB (CK-MB) release. hFABP is a faster marker of perioperative myocardial damage.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgery procedure.
- Assessing perioperative myocardial injury is crucial for patient outcomes.
- On-pump CABG utilizes cardiopulmonary bypass and cardioplegic arrest, while off-pump CABG is performed on a beating heart.
Purpose of the Study:
- To compare myocardial injury between on-pump and off-pump CABG using cardiac biomarkers.
- To evaluate the kinetics of heart-type fatty-acid-binding protein (hFABP) and creatine kinase-MB (CK-MB) release in both surgical approaches.
Main Methods:
- Prospective study involving 50 patients randomly assigned to on-pump or off-pump CABG.
- Serial measurements of hFABP and CK-MB concentrations in venous blood samples.
- Sampling occurred at multiple time points before and after the surgical procedure.
Main Results:
- Significantly higher total release of hFABP and CK-MB in the on-pump group compared to the off-pump group (P < 0.0001 for hFABP, P < 0.001 for CK-MB).
- hFABP levels peaked earlier (1-2 hours) than CK-MB levels (4-24 hours) in both groups.
- Lower biomarker release in off-pump CABG suggests reduced myocardial damage.
Conclusions:
- On-pump CABG with cardioplegic arrest leads to greater myocardial damage than off-pump CABG.
- hFABP is a more sensitive and rapid marker of perioperative myocardial damage compared to CK-MB.
- hFABP may aid in predicting the need for intensive monitoring for postoperative myocardial infarction.
Abstract:
This prospective study uses heart-type fatty-acid-binding protein (hFABP) and creatine kinase-MB (CK-MB) release to compare myocardial injury in on-pump versus off-pump coronary artery bypass grafting (CABG). Fifty patients were randomly assigned to on-pump or off-pump CABG. The hFABP and CK-MB concentrations were measured in serial venous blood samples drawn before heparinization in both groups and after aortic unclamping at 1, 2, 4, 8, 24, 48, and 72 hours in the on-pump group. In the off-pump group, samples were taken after the last distal anastomosis at the same time intervals as in the on-pump group. The total amount of hFABP and CK-MB released was significantly higher in the on-pump than in the off-pump group (hFABP = 100.43 +/- 77.63 vs 3.94 +/- 0.36 ng/mL, P < 0.0001; CK-MB = 33.33 +/- 3.81 vs 28.65 +/- 3.91 log units, P < 0.001). In all patients, hFABP levels peaked as early as 1 hour after declamping (on-pump group) or 2 hours after the last distal anastomosis (off-pump group), whereas CK-MB peaked only at 4 hours after declamping (on-pump group) or 24 hours after the last distal anastomosis (off-pump group). The lower release of hFABP and CK-MB in the off-pump CABG group indicates that on-pump CABG with cardioplegic arrest causes more myocardial damage than does off-pump CABG. Heart-type fatty-acid-binding protein is a more rapid marker of perioperative myocardial damage, peaks earlier than CK-MB, and may predict the requirement for intensive monitoring for postoperative myocardial infarction.
