Outcomes following coronary artery bypass grafting with multiple arterial grafting by pump status in men and women

Background: Multiple arterial grafting (MAG) and off -pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). This study was conducted to determine the impact of off -pump surgery on outcomes after CABG with MAG in men and women. Methods: This cohort study used population -based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019. The primary outcome was all -cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE; hospitalization for stroke, myocardial infarction hospitalization or heart failure, or repeat revascularization). Analysis used propensity -score overlap -weighted cause -specific Cox proportional hazard regression. Results: A total of 2989 women (1188 off -pump, 1801 on -pump) and 16,209 men (6065 off -pump, 10,144 on -pump) underwent MAG with a median follow-up of 5.0 years (interquartile range, 2.7-8.0) years. Compared to the on -pump approach, all -cause mortality was not changed with off -pump status (hazard ratio [HR] in women: 1.25 [95% CI, 0.83-1.88]; in men: 1.08 [95% CI, 0.85-1.37]). In women, the risk of MACCE was significantly higher off -pump (HR, 1.45; 95% CI, 1.04-2.03), with nonsignificantly increased risk observed for all component outcomes. Conclusions: In patients undergoing CABG with MAG, this population -based analysis found no association between pump status and survival in either men or women. However, it did suggest that off -pump MAG in women may be associated with an increased risk of MACCE. (J Thorac Cardiovasc Surg 2024;167:1796-807)