OBJECTIVE We compared 10-year graft patency rates and long-term clinical outcomes after off-pump coronary artery bypass grafting using the saphenous vein composite grafts based on the left internal thoracic artery with those using total arterial composite grafts. METHODS A total of 483 patients who underwent off-pump coronary artery bypass grafting using composite grafts based on the left internal thoracic artery were included. The saphenous vein was used as a second (connected to the left internal thoracic artery; n = 63) or a third (connected to the second arterial graft; n = 40) composite graft in 103 patients (SV group); total arterial composite grafting was performed in 380 patients (ART group). A propensity score-matched analysis was used to match the SV group to the ART group (n = 103 patients in each). The median follow-up duration was 128 (97-139) months. RESULTS There were no differences in operative mortality and postoperative complication rates between the 2 matched groups. Propensity score-matched analyses showed no differences in the overall survival and freedom from cardiac death rates between the 2 groups (P = .369 and P = .206, respectively) up to 12 years after surgery. Freedom rates from reintervention and major adverse cardiac and cerebrovascular events were also similar between the 2 matched groups (P = .695 and P = .758, respectively) up to 12 years after surgery. Generalized mixed-effects models showed that the 2 matched groups demonstrated no differences in overall and composite graft patency rates during 10 years after surgery (P = .568 and P = .702, respectively). CONCLUSIONS The saphenous vein composite grafts were equivalent to arterial composite grafts in terms of 10-year graft patency and long-term clinical outcomes.