Background: Off-pump coronary artery bypass grafting, avoiding the use of cardiopulmonary bypass, has attracted the interest of an increasing number of surgeons and patients, and has assumed an increasing role in surgical practice. Whether Off-pump coronary artery bypass grafting have better outcome in high-risk patients as compared to Conventional coronary artery bypass grafting remains to be confirmed. We describe an analysis of early clinical outcomes of high-risk CAD patients, subjected to both techniques. Methods: We studied 450 patients with additive EuroSCORE of ≥5 on admission. Patients were divided into 2 groups; Group A was assigned for patients underwent conventional coronary artery bypass grafting, and Group B for patients underwent Off-pump coronary artery bypass grafting. Data, including gender, age, demographic variables and postoperative complications were extracted from the medical records. Results: Both groups were matched with regard to age, gender, smoking, Diabetes mellitus, dyslipidemia, renal hemodialysis and the mean Euro- Score. We demonstrated a decrease in the incidence of early postoperative AF and renal failure in the Off-pump group. However, we recorded no statistical difference of neurologic complications, acute myocardial infarction or early mortality between the two groups. Conclusion: we recommend Off-pump coronary artery bypass grafting in high-risk coronary disease patients, as this technique may carry potential benefits without compromising their clinical outcomes.