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Introduction Mean platelet volume (MPV) is claimed to be a useful marker to predict long-term risk for major adverse cardiac effects (MACE) in patients undergoing percutaneous coronary interventions (PCI). Aim To explore the possible dependence on MPV and postoperative PCI risk in patients with complex coronary artery disease undergoing coronary artery bypass grafting in off-pump technique (OPCAB). Material and methods We retrospectively analyzed 236 consecutive patients (180 (76%) males and 56 (24%) women) referred for surgery due to complex coronary artery disease between 2015 and 2016 in our department. The mean 5.1 ±0.8 year follow-up included profound analysis of MACE events including acute coronary syndromes and percutaneous interventions. Results The 5 ±1 year follow-up was completed by 213 (90%) patients with 2 (1%) deaths within the first year after surgery. In logistic univariate and multivariate model regression analysis two parameters were found significant, i.e. preoperative white blood cells and postoperative MVP, for PCI risk in long-term follow-up. The odds ratio values for postoperative MPV were 1.78 (95% CI, p = 0.0036) and 1.76 (95% CI, p = 0.005) in univariate and multivariate models with cutoff point > 8.7, sensitivity 45.65%, specificity 78.72%. Conclusions MPV can be regarded as a simple marker of PCI risk following OPCAB procedures. The preoperative MPV indicates the individual tendency for worse prognosis more than procedure dependence.