Sex-differences in outcome after off-pump coronary artery bypass grafting is age-dependent; data from the Netherlands Heart Registration

Background: Women are known to have worse outcome after coronary artery bypass grafting (CABG) than men. Studies have shown that off-pump coronary artery bypass grafting (OPCAB) might benefit higher-risk patients, and therefore might also benefit women. We aimed to determine differences in early and late outcomes between sexes after OPCAB.Methods: Data from all patients undergoing OPCAB, between 2013 through 2021 was retrieved from the Netherlands Heart Registration (NHR) database. Primary outcomes were early mortality, morbidity and late survival. We divided the population into subgroups based on age (aged >= 70 years or < 70 years) and sex.Results: This study included 8,487 men and 2,170 women (total = 10,657). Female patients received fewer anastomoses (mean (SD)) women 2.38 (1.17) vs men 2.68 (1.23), p < 0.001) and total arterial revascularization was performed less frequently in women than in men (21.3 % versus 29.5 % respectively, p < 0.001). In the subgroup of patients <70 years, early mortality was 1.7 % in women and 0.6 % in men (p < 0.001). Survival rate at 5 years was 88.4 % in women and 91.1 % in men (p < 0.001). Female sex was associated with worse late survival in the subgroup <70 years (HR (95 % CI) 1.42 (1.10-1.83) p = 0.008). Conclusions: Sex-differences in outcome after CABG persists in OPCAB surgery. However, these differences are solely present in the younger sub-group. In our data, women undergoing OPCAB surgery seem to be treated differently during surgery as compared to their male counter parts, further research is needed to analyze this finding.