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This study reviews sex disparities in grafting strategy and outcomes in the Netherlands, comparing survival among younger patients treated with multi-arterial grafting. Retrospective data from the Netherlands Heart Registration were analyzed with risk-adjusted Cox proportional hazards models for revascularization strategy and postoperative outcomes. Secondary analysis focused on patients aged 70 or younger at baseline. A total of 51,137 patients were included, with 19.1% women.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/sex-related-differences-in-single-and-multiarterial-coronary-artery-bypass-grafting-insights-from-the-netherlands-heart-registration/408465/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/sex-related-differences-in-single-and-multiarterial-coronary-artery-bypass-grafting-insights-from-the-netherlands-heart-registration/408465.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How did the study assess sex differences in grafting strategy and outcomes?","Question",{"text":113,"@type":114},"It used retrospective data from the Netherlands Heart Registration and applied risk-adjusted Cox proportional hazards regression analysis to evaluate the effect of sex on revascularization strategy and postoperative outcomes.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What was the secondary analysis population?",{"text":118,"@type":114},"The secondary analysis examined a subset of patients aged 70 years or younger at baseline.",{"name":120,"@type":111,"acceptedAnswer":121},"What survival pattern was observed in younger patients when treated with multi-arterial grafting?",{"text":122,"@type":114},"In the younger population, a survival benefit was observed with multi-arterial grafting, to the point where survival did not differ between sexes.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},408465,1790716608,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":41,"preview_page_count":4},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","OPEN ACCESS  \nCitation: Beukers SHQ, Daeter EJ, Derks  \nL, Kloppenburg GTL (2025) Sex-related differences in single-and multi-arterial coronary artery bypass grafting: Insights from the Netherlands Heart Registration. PLoS One 20(12): e0336035. [https://doi.org/10.1371/](https://doi.org/10.1371/)[ ](https://doi.org/10.1371/)[journal.pone.0336035](journal.pone.0336035)  \nEditor: Redoy Ranjan, James Cook University Hospital, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND  \nReceived: February 12, 2025  \nAccepted: October 20, 2025  \nPublished: December 31, 2025  \nCopyright: © 2025 Beukers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.  \nData availability statement: The data underlying the results presented in the study are available from The Netherlands Heart Registration (NHR) through their website: [https://nhr.nl](https://nhr.nl. The)[. The](https://nhr.nl. The)  \nRESEARCH ARTICLE  \nSex-related differences in single-and multiarterial coronary artery bypass grafting: Insights from the Netherlands Heart Registration  \nSophie H.Q. Beukers1*, Edgar J. Daeter1, Lineke Derks2, Geoffrey T.L. Kloppenburg1, on behalf of the Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration¶  \n1 Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands,  \n2 Netherlands Heart Registration, Utrecht, the Netherlands  \n¶ Membership of the Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration is provided in the Acknowledgments  \n* [s.beukers@antoniusziekenhuis.nl](s.beukers@antoniusziekenhuis.nl)  \nAbstract  \nWomen are known to suffer from increased mortality and major adverse cardiac events rates after coronary artery bypass grafting compared to men. This study gives an overview of sex-disparities in grafting strategy and outcome of coronary artery bypass grafting in the Netherlands, and compares survival of the younger population undergoing multi-arterial grafting. Data were gathered retrospectively from the Netherlands Heart Registration database. Patients undergoing isolated after coronary artery bypass grafting were divided into groups treated with single or multi-arterial grafting. Using risk adjusted cox proportional hazard regression analysis, the effect of sex on the revascularization strategy and postoperative outcomes was assessed. Secondary analysis was conducted on a subset of patients aged 70 years or younger at baseline. The study included 51137 patients, of which 19. 1% was female. When compared to men, women were older and suffered from more comorbidity. Female sex was independently associated with less multi-arterial grafting. While multiarterial grafting led to a lower repeat revascularization rate in men (p = 0.022), this was not the case in women. Cox regression analysis did not independently associate the female sex with inferior survival. In the younger population, a survival benefit was observed after multi-arterial grafting, to the point where survival did not differ between sexes. Women receive fewer arterial grafts as opposed to men. In a younger patient population, the survival difference between sexes disappears when patients are treated with multi-arterial grafting.  \nPLOS One | [https://doi.org/10.1371/journal.pone.0336035](https://doi.org/10.1371/journal.pone.0336035) December 31, 2025 1 / 12  \nNHR can be contacted by email ([info@nhr.nl](info@nhr.nl)) or by phone (031-088 – 2200 900) .  \nFunding: This study was supported by The Academy of the St Antonius Hospital (research and development unit; Nieuwegein, The Netherlands) by financing the costs of open access publication. The authors did not receive other funding. The funders of the publication had no role in study design, data collection and analysis, decision to publish, or preparat","cbCaibCaT7c5IVE1","https://ap.wps.com/l/cbCaibCaT7c5IVE1","pdf",519005,12,"English","# Abstract\n# Introduction","[{\"question\":\"How did the study assess sex differences in grafting strategy and outcomes?\",\"answer\":\"It used retrospective data from the Netherlands Heart Registration and applied risk-adjusted Cox proportional hazards regression analysis to evaluate the effect of sex on revascularization strategy and postoperative outcomes.\"},{\"question\":\"What was the secondary analysis population?\",\"answer\":\"The secondary analysis examined a subset of patients aged 70 years or younger at baseline.\"},{\"question\":\"What survival pattern was observed in younger patients when treated with multi-arterial grafting?\",\"answer\":\"In the younger population, a survival benefit was observed with multi-arterial grafting, to the point where survival did not differ between sexes.\"}]","Sex-related differences in single-and multiarterial coronary artery bypass grafting: Insights from the Netherlands Heart Registration | PDF",1790579487]