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ABSTRACT Introduction: According to the American Heart Association guideline for coronary artery bypass grafting (CABG), female patients undergoing on-pump CABG (ONCAB) are at higher risk of short-term adverse outcomes than male patients. However, whether off-pump CABG (OPCAB) can improve the short-term outcome of female patients compared to ONCAB remains unclear. Methods: We conducted a meta-analysis to study the effect of the female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115 patients were enrolled in 12 studies, including 20,245 females who underwent ONCAB and 10,910 females who underwent OPCAB. Results: The in-hospital mortality in female patients who underwent OPCAB was significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without (OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The incidence of postoperative stroke in female patients who underwent OPCAB was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI 0.48-0.73) before cardiovascular risk factor adjustment but was not significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no significant difference in the incidence of postoperative myocardial infarction between women who underwent OPCAB and those in the ONCAB group (1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). Conclusion: In contrast to the American Heart Association CABG guideline, female patients who had OPCAB don’t have unfavorable outcomes compared with the ONCAB group. Introduction CABG, , (CABG) onpump pump (ONCAB shortterm short term However offpump off (OPCAB unclear Methods metaanalysis meta analysis vs 31115 31 115 31,11 1 studies 20245 20 245 20,24 10910 10 910 10,91 Results inhospital hospital 2.7% 27 2 7 (2.7 3.4% 34 3 4 [OR 0.76 076 0 76 95 [CI 0.650.89 065089 0.65 0.89 65 89 0.65-0.89 0.68 068 68 0.520.89 052089 0.52 52 0.52-0.89 1.2% (1.2 2.1% 21 0.59 059 59 0.480.73 048073 0.48 0.73 48 73 0.48-0.73 0.87 087 87 0,661.16 066116 0,66 1.16 66 16 0,66-1.16 1.3% 13 (1.3 2.3% 23 0.88 088 88 0.541.43. 054143 0.54 1.43 . 54 43 0.54-1.43) Conclusion dont don t (CABG 3111 11 31,1 2024 24 20,2 1091 91 10,9 2.7 (2. 3.4 0.7 07 9 650 0.650.8 06508 065 0.6 089 0.8 6 8 0.65-0.8 06 520 0.520.8 05208 052 0.5 5 0.52-0.8 1.2 (1. 2.1 05 480 0.480.7 04807 048 0.4 073 0.48-0.7 08 661 0,661.1 06611 066 0,6 116 1.1 0,66-1.1 1.3 2.3 541 0.541.43 05414 054 143 1.4 0.54-1.43 311 31, 202 20, 109 10, 2. (2 3. 0. 0.650. 0650 0.65-0. 0.520. 0520 0.52-0. 1. (1 0.480. 0480 04 0.48-0. 0,661. 0661 0, 0,66-1. 0.541.4 0541 14 0.54-1.4 ( 0.650 0.65-0 0.520 0.52-0 0.480 0.48-0 0,661 0,66-1 0.541. 0.54-1. 0.65- 0.52- 0.48- 0,66- 0.541 0.54-1 0.54-