Risk Factors for Bleeding Events After One-Stop Hybrid Coronary Revascularization

Background: Gastrointestinal bleeding events represent a serious complication after coronary revascularization. In recent years, hybrid coronary revascularization (HCR) has gradually become one of the main surgical methods for multivessel coronary artery disease. This study aimed to identify risk factors for gastrointestinal bleeding following one-stop HCR. Method: This single-center retrospective study included 231 patients with coronary artery disease who underwent one-stop HCR between April 2018 and April 2023. Baseline conditions and perioperative parameters of patients were collected from electronic medical records; gastrointestinal bleeding events were documented, and retrospective statistical analyses were performed. Results: Among the 231 patients, 12 experienced gastrointestinal bleeding events, yielding an incidence rate of 5.2%; three patients died due to gastrointestinal bleeding, corresponding to a mortality rate of 25.0% among patients with bleeding events. Compared with patients without bleeding events, those with gastrointestinal bleeding had significantly higher rates of prior cerebrovascular disease (50.0% vs. 21.0%), preoperative creatinine (defined as the last serum creatinine measured within 24 h before surgery) (78.5 vs. 67.7 μmol/L), perioperative total blood transfusion volume during the period (600 vs. 0 mL), perioperative blood transfusion >5 units (33.3% vs. 8.7%), intraoperative bleeding volume (400 vs. 200 mL), total postoperative drainage volume (1453 vs. 1160 mL), mechanical ventilation time (18.0 vs. 16.0 h), and mortality (25.0% vs. 3.2%) (all p < 0.05). Single-factor and multi-factor regression analyses identified prior cerebrovascular disease (CVD) as an independent risk factor for gastrointestinal bleeding (odds ratio (OR) = 3.754, 95% confidence interval (CI) = 1.202–11.724; p = 0.023). Mortality was significantly higher in the gastrointestinal bleeding group than in the control group. Conclusion: Previous cerebrovascular disease is a risk factor for gastrointestinal bleeding after one-stop HCR. In such patients, antiplatelet strategies should be appropriately adjusted to prevent and reduce gastrointestinal bleeding. However, the number of events in our study was limited, and future studies should incorporate larger sample sizes to validate these findings.