J Am Heart Assoc. 2026 Apr 16:e040875. doi: 10.1161/JAHA.124.040875. Online ahead of print.
ABSTRACT
BACKGROUND: Upper gastrointestinal bleeding is a severe postoperative complication after coronary artery bypass grafting. We aimed to identify the incidence, predictors, and outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions within 30 days after coronary artery bypass grafting from a nationwide database.
METHODS: The Nationwide Readmission Database 2016 to 2020 was queried to identify patients who had isolated coronary artery bypass grafting and were readmitted with NVUGIB in 30 days. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System codes were used to identify the cohort. As the Nationwide Readmission Database is an anonymous public database, the study was exempt from the institutional review board. The analysis was conducted using Stata 17 (StataCorp LLC, College Station, TX).
RESULTS: Of 801 221 patients who underwent isolated coronary artery bypass grafting, 784 280 were discharged alive. Within 30 days, of the 5180 patients who were readmitted with a diagnosis of NVUGIB, the mortality rate was 5.4%. Compared with nonreadmitted patients, patients with NVUGIB had a lower proportion of women (25.4% versus 31.2%, P<0.001) but higher comorbidity burdens, such as atrial fibrillation (44.4% versus 39.1%, P<0.001), and blood transfusion (39.1% versus 6.0%, P<0.001). Key predictors for 30-day readmission with NVUGIB were atrial fibrillation (hazard ratio [HR], 1.31 [95% CI, 1.20-1.44]; P<0.001) and higher age (>65 years) (HR, 1.25 [95% CI, 1.01-1.53]; P=0.04). Female sex (odds ratio, 2.01 [95% CI, 1.28-3.17]; P=0.002) was strongly associated with death. Early (≤24 hours) esophagogastroduodenoscopy had better mortality outcomes (odds ratio, 0.23 [95% CI, 0.09-0.53]; P<0.001).
CONCLUSIONS: NVUGIB readmissions after coronary artery bypass grafting are linked to significant morbidity and death. Early esophagogastroduodenoscopy is associated with improved outcomes, emphasizing its role in management.
PMID:41988973 | DOI:10.1161/JAHA.124.040875