Managing antithrombotic therapy in patients with atrial fibrillation (AF) and myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) remains clinically challenging because of competing bleeding and thrombotic risks. An observational study presented at EuroPCR 2026 evaluated whether diabetes mellitus (DM) alters the balance between ischemic and hemorrhagic risk in patients with AF and MI treated with PCI.
The analysis included 147 consecutive patients, including 67 patients with DM and 80 without DM. Bleeding and thrombotic risks were assessed using Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria, PRECISE-DAPT, and PRECISE-HBR scores. The ARC-HBR trade-off model was used to classify patients according to whether bleeding risk exceeded, equaled, or remained lower than thrombotic risk.
Findings
- Patients with DM had significantly higher PRECISE-DAPT scores than those without DM (32.2 ± 10.6 vs 27.7 ± 11.0; p = 0.013).
- Estimated annual ischemic risk for myocardial infarction or stent thrombosis was markedly higher in patients with DM (10.0% ± 5.3% vs 5.7% ± 2.8%; p < 0.001).
- Patients with DM also had higher estimated TIMI major/minor bleeding risk compared with those without DM (2.8% ± 1.1% vs 2.3% ± 1.1%; p = 0.009).
- Thrombotic-risk dominance was identified more frequently in patients with DM than in those without DM (40.3% vs 22.4%).
- Bleeding risk exceeded thrombotic risk less frequently in patients with DM compared with those without DM (22.4% vs 45.0%).
Among patients with AF and MI undergoing PCI, DM was associated with both higher estimated bleeding risk and substantially higher ischemic risk. The findings suggest that diabetes contributes to a high-risk clinical profile in which bleeding and thrombotic hazards coexist, supporting the need for individualized antithrombotic treatment strategies in this population.
