The aim of this study is evaluate the outcomes of myelodysplastic syndrome on multivessel coronary artery disease. A 72-year-old male who had been diagnosed as myelodysplastic syndrome (MDS) referred for effort angina. On coronary angiography, critical 80% stenosis of the left main coronary artery and multivessel coronary artery disease (MVCAD) determined. On complete blood count the number of platelets was about 10-20^3/µL. We administered platelet replacement twice daily to increase the number of platelets to prevent hemorrhage for a week. This case was characterized with hemodynamic instability and difficulties in MDS after off pump coronary artery bypass grafting (OPCAB) due to thrombocytopenia of varying severity. He was stabilized after increasing the number of platelets. Herein, we have published this case due to its rarity and difficulty in decision-making.
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