Abstract: Objective · To explore the difference between multi-artery-graft off-pump coronary artery bypass grafting (OPCABG) and single-artery-graft OPCABG on left main coronary artery or multivessel disease with propensity score matching.  Methods · A total of 1 578 patients with left main coronary artery or multivessel disease underwent isolated OPCABG were selected in Ruijin Hospital from January 2012 to September 2016. The propensity score methodology was used to obtain risk-adjusted outcome. Kaplan-Meier analysis was applied for estimation of freedom from major adverse cardiac and cerebrovascular events (MACCE) and readmission for heart disease. Independent predictor of MACCE were assessed by Cox regression analysis.  Results · The average follow-up time was 28 months (7-55 months). There was no statistical difference in short-term clinical endpoints in hospital. In the follow-up results, multi-artery-graft OPCABG patients had statistical improvement in readmission for heart disease (2.7% vs 12.7%, P=0.023), CCS class (1.2±0.4 vs 1.4±0.6, P=0.020) and patency rate of grafts in 1 year after operation (95.8% vs 85.9%, P=0.025), compared with single-artery-graft OPCABG. There was no statistical difference in other endpoints. There was statistical improvement for multi-artery-graft OPCABG patients in freedom from readmission for heart disease (P=0.028). Female was an independent predictor of MACCE (95% CI 0.117-0.906, P=0.032).  Conclusion · Multiartery-graft OPCABG appears to be safe and with good patency of grafts and clinical outcomes in treating left main coronary artery or multivessel disease. The follow up of female patients should be paid more attention.

Key words: multi-artery-graft, off-pump coronary artery bypass grafting, propensity score matching