Jeffrey L Carson 1, Maria Mori Brooks 1, Paul C Hébert 1, Shaun G Goodman 1, Marnie Bertolet 1, Simone A Glynn 1, Bernard R Chaitman 1, Tabassome Simon 1, Renato D Lopes 1, Andrew M Goldsweig 1, Andrew P DeFilippis 1, J Dawn Abbott 1, Brian J Potter 1, Francois Martin Carrier 1, Sunil V Rao 1, Howard A Cooper 1, Shahab Ghafghazi 1, Dean A Fergusson 1, William J Kostis 1, Helaine Noveck 1, Sarang Kim 1, Meechai Tessalee 1, Gregory Ducrocq 1, Pedro Gabriel Melo de Barros E Silva 1, Darrell J Triulzi 1, Caroline Alsweiler 1, Mark A Menegus 1, John D Neary 1, Lynn Uhl 1, Jordan B Strom 1, Christopher B Fordyce 1, Emile Ferrari 1, Johanne Silvain 1, Frances O Wood 1, Benoit Daneault 1, Tamar S Polonsky 1, Manohara Senaratne 1, Etienne Puymirat 1, Claire Bouleti 1, Benoit Lattuca 1, Harvey D White 1, Sheryl F Kelsey 1, P Gabriel Steg 1, John H Alexander 1; MINT Investigators
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PMID: 37952133DOI: 10.1056/NEJMoa2307983Abstract
Background: A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.
Methods: In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.
Results: A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).
Conclusions: In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.).
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