 However, in our opinion, the definition of high-risk patient should be interpreted carefully, since the EuroSCORE identifies patients based on 18 independent variables, many of which were not considered in the study. Risk factors such as previous cardiac surgery, critical preoperative state, emergency operation, and poor left ventricular dysfunction were excluded. Furthermore, active endocarditis, pulmonary hypertension, other than isolated CABG, surgery on the thoracic aorta, and postinfarction septal rupture were not considered due to the nature of the study. Chronic pulmonary disease and neurological dysfunction were not defined according to EuroSCORE, and there is no information on patients with unstable angina. In the real world, with more than 1500 patients, we showed lower mortality among patients who underwent off-pump CABG10. So, after a certain cut-off EuroSCORE 4.5 or 2000 Bernstein-Parsonnet score 17.75, off-pump CABG significantly reduces death rates. Indeed, numerous large retrospective studies and meta-analyses have shown significant short-term improvements after OPCAB and comparable long-term outcomes. A recent risk-adjusted analysis of the national Society of Thoracic Surgeons STS database assessing 876,081 patients demonstrated a significant reduction in death and stroke 11 and 34 reduction, respectively after OPCAB, seen in both low- and high-volume centers11. After that, it is important to reconsider the best approach for patients with higher surgical risk for CABG. 