Objective To investigate clinical outcomes and perioperative management of off-pump coronary artery bypass grafting （OPCAB） for patients following acute myocardial infarction （AMI）.?Methods?From January 2006 to March 2010， 239 consecutive patients underwent OPCAB on the 14-27 （20.55±3.91） d following AMI（AMI group）in Renji Hospital，School of Medicine of Shanghai Jiaotong University. Preoperative MB isoenzyme of creatine kinase（CK-MB） level was （15.82±6.24） U/L and cardiac troponin I（cTnI） was （0.07±0.04） ng/ml. Clinical data of 406 patients without myocardial infarction history who underwent OPCAB during the same period were also collected as the control group for comparison.?Results?The 30-day mortality of AMI group was 2.51% （6/239）. The causes of death were circulatory failure in 4 patients， ischemic necrosis of lower extremity caused by intra-aortic balloon pump （IABP） in 1 patient and pneumonia with septic shock in 1 patient. Dopamine usage in AMI group was significantly higher than that of the control group （61.51% vs. 37.44%， P=0.001）. Intraoperative or postoperative IABP implantation was more common in AMI group， but there was no statistical difference between the two groups（P＞0.05） . Postoperative drainage and blood transfusion in AMI group were significantly larger than those of the control group （385.18±93.22 ml vs. 316.41±70.05 ml， P=0.022；373.68±69.54 ml vs. 289.78±43.33 ml， P=0.005， respectively）. But there was no statistical difference in re-exploration rate between the two groups （P＞0.05）. There was no statistical difference in the incidence of postoperative new onset atrial fibrillation between the two groups （P＞0.05）. Incidence of acute kidneyinjury of AMI group was significantly higher than that of the control group （13.81% vs. 8.62%， P=0.038）. Postoperative 30-day mortality of AMI group was higher than that of the control group， but there was no statistical difference between the two groups （2.51% vs. 1.48%，P＞0.05）. There was no statistical difference in ICU stay time and postoperative hospital stay between the two groups （2.01±0.95 d vs. 1.78±0.98 d；10.33±4.16 d vs. 9.89±4.52 d， respectively， P＞0.05）. A total of 211 patients （88.28%）in AMI group were followed up for 2.89±1.02 years， and 28 patients （11.72%） were lost during follow-up. Twenty-five patients died during follow-up including 14 cardiac deaths. One-year survival rate was 97.63%， and five-year survival rate was 88.15%.?Conclusion?It’s comparatively safe to perform OPCAB for patients at 2-4 weeks following AMI when their CK-MB and cTnI levels have returned to normal range.