Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction
Authors: Carrier François M. , Cooper Howard A. , Portela Gerard T. , Bertolet Marnie , Lemesle Gilles , Prochaska Micah , Kim Sarang , Alexander John H. , Crozier Ian , Ducrocq Gregory , Quadros Alexandre S. , Bagai Akshay , Dracoulakis Marianna , Madan Mina , Brooks Maria M. , Carson Jeffrey L. , Hébert Paul C. ,   MINT Investigators, Carson Jeffrey L. , Chen Fei , Desanto Patrick , Dragert Karen , Kostis William J. , Kim Sarang , McCloskey Deborah , Noveck Helaine , Redding Sheila , Patel Ami , Ghafghazi Shahab , Vincent Sharon , Dholiya Hardeep , Kalra Dinesh , Moore Jennifer , Hatfield Mallory , Cooper Howard A. , Haidry Syed , Hassanin Ahmed , Kaul Risheek , Namrata Fnu , Sharedalal Parija , Sreenivasan Jayakumar , Bhinder Jasjit , Hasan Khan Mohammed , Koulova Anna , Mody Behram , Rochlani Yogita , Tirumani Anuritha , Wood Frances , Norton Rhonda , Daniel LaMonica , Menegus Mark , Baboolall Samanta , Davila Sheila , Manning Noelle , Machado Mollie , Rauch Judah , Camilo Angeline , Hernandez Estefania , Iqbal Muhammad , Mazniku Ervin , Ramirez Odilis , Day Veronica , Uretsky Barry , Byrd Jesse , Miller Kristin , Vallurupalli Srikanth , Maniatis Gregory , Dima Richard , Royzman Roman , Taylor Sean , Tice Amanda , Dilluvio Brandon , Gruberg Luis , Gandotra Puneet , Gentles Rachel , Shannon Barbara , Masih Maria , Roswell Robert , Gulliver Alana , Ruhani Meriton , Strober Emily , Tamazi Samia , Gershon Adam , Coleman Kristie , Kadosh Bernard , Jauhar Rajiv , Adnani Harsha , Agostini Kyle , Boutis Loukas , Dalangin Ian , Kaplan Barry , Lee Jae S. , Meraj Perwaiz , Timmons Riona , Reimers Carl , Basman Craig , Rashid Umar , Garvey Rene Aglae , Mellor Asha , duBourg Karen , Rossi Joseph , Orgel Ryan , Reynolds Emma , Scholl Tatum , Bogan Janet , Bogdan Olivia , Cavender Matt , Cosentino Gaetana , De Jesus Gabriela , Gonzalez Megan , Hoang Julia , Kleemann Emma , Ravenscraft Deanna , Reed Teresa , Roark Joshua , Smith Samantha , Sternat Kaitlyn , Tate Oreyane , Wade Tyrone , Wolf Hope , Abtahian Farhad , Littleton Megan , Malchoff Kayla , Mohr Kelly , Pierce Emily , LaLonde Jennifer , Sherron Kellie , Albro Tia , Noll Patty , Tessalee Meechai , Eaton Claudia , Barsness Gregory , Albers Diana , Jentzer Jacob , Abbott J. 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Yamamoto Joyce , Precoma Dalton , Correa Cristina , Martins Maynara , Rochitti Carlos , Richter Camila , Nakashima Carlos A.K. , Sehnem Eliane , Toledo Campo Dall’Orto Frederico , Rogante Ribeiro Gislayne , Bergo Ricardo Reinaldo , Pedroso Dias Corsini Claire Marie , Ferreira Kemilys Marine , De Andrade Pedro B. , Barbosa Robson A. , Dracoulakis Marianna , Alvaia Natalia , Dourado Rodolfo , Ribeiro Jéssica , Vieira Camilla , Sarmento Taís , Giacomo Aline , Lopes Mariana , Maia Lília N. , Costa Osana , Dutra Paulo Jhones , Frassatto Danieli , Garcia Juliana Vieira , Lemos Maria Angélica , Loverdi Thaise , Nakazone Marcelo , Prado Nadielly , Da Silva Júnior Osvaldo , Cordeiro da Silva Natalia , Gomes Sidney , Centurione Anna Helena Felipe Pereira , Fontelles Ritt Luiz Eduardo , Borges De Oliveira Queila , De Carvalho Cordeiro Karina , Quadros Alexandre , Bonatto Giulia , Machado Bruna , Poleth Silvia , Correia Camille , Guimarães Raphael , Cabral Israel , Sobral Filho Dário Celestino , 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, Gautier Alexandre , Mesnier Jules , Puymirat Etienne , Sriwaran Mélissa , Elysee Rachel , Fayol Antoine , Grelier Amandine , Hafsi Nesrine , Rakotosamimanana Hasina , Tea Victoria , Arab Sarah , Irekti Hinde , Lemesle Gilles , Druart Anne , Pilat Isabelle , Verdier Basile , Ferrari Emile , Fourrier Etienne , Labbaoui Mohamed , Redjimi Nassim , Zamiti-Smondel Amina , Bencherif Rabab , Lattuca Benoit , Delelo Elodie , Silvain Johanne , Barthelemy Olivier , Benattia Fatima , Devos Perrine , Merbah Soraya , Posson Juliane , Procopi Nikki , Wallet Thomas , Zeitouni Michel , Ferrante Arnaud , Granger Camille , Manzo-Silberman Stéphane , Salloum Tomy , Vanzetto Gérald , Barone Rochette Gilles , Blanc Vannet Sara , Charlon Clémence , Crebier Océane , Marliere Stéphanie , Peretout Pauline , Hildt Julie , Cetran Laura , Baudinet Thomas , Coste Pierre , Ruissel Amandine , Servat Marine , Lhermusier Thibault , Bouisset Frédéric , Campelo-Parada Francisco , Lemoine Kimberly , Nasr Mouin , Poisay Marine , Servoz Clément , Tribeau Stéphanie , Cottin Yves , Bichat Florence , Saint-Jalmes Mailis , Buzura Victor , Rosamel Yann , Hadjih Sarah , Angoulvant Denis , Collet Emilie , Ivanes Fabrice , Lassouani Katia , Mouzouri Mohammed , Naudin Djedjiga , Genet Thibaud , Dillinger Jean Guillaume , Bennacer Nadhira , Cacoub Lea , Lequipar Antoine , Mahtout Baya , Thuaire Christophe , Leniliot Marina , Tachot Emilie , Thobois Corine , Vassaliere Christel , Popovic Batric , Breistroff Jessica , Gutehrle Aurelie , Saint-Gilles Maximilien , Varlot Jeanne , Durand Eric , Beziau-Gasnier Delphine , Bouhzam Najime , Catherine Solenn , Marais Bryan , Tron Christophe , Vezier Claire , Hemery Thibaut , Bouleti Claire , Ramonatxo Arthur , Azzakani Sonia , Berger Nathalie , Boucher Celine , Roubille François , Bonneton Chloé , Desmoulin Gautier , Huet Fabien , Kahlouche Sandra , Delorme Laurent , Andrieu Angélique , Molina-Martin De Nicolas Javier , Durand Nathalie , Berous Marion , André Romain , Crozier Ian , Elliott John , Cruickshank Catherine , El Banna Houda , Hume Michael , Benatar Jocelyne , Somaratne Jithendra , Gatland Diana , Kistanna Danica , Patten Cathrine , Singh Doreen , Nandra Samraj , Low Chuen Siang , Vallancey Susan , Ternouth Ian , Dalman Neelam , Easton Aleisha , Jackson Carolyn , Kirkham Simon , Vickers Cathy , Fisher Nick , Koelle Jette , McNab Charlotte , Brieger David , Pathan Shahab , Rubenis Imants , Swe Su , Virk Sohaib , Hillis Graham , Bonner Michelle , Dias Charmaine , Hillis Lorraine , Brooks Maria Mori , Alexander John H. , Goodman Shaun G. , Hébert Paul C. , Lopes Renato D. , Simon Tabassome , White Harvey , Alsweiler Caroline , Chaitman Bernard R. , Fergusson Dean A. , Morton Erin , Triulzi Darrell J. , Barbosa Lilian Mazza , de Barros e Silva Pedro Gabriel Melo , Arnaldi Seixas Liliane A T , Arantes Paola E. , Teixeira Aleixo Silva Larissa , Beatriz Oliveira Damásio Georgia , Berard Laurence , Rousseau Alexandra , Paco Sandra , Benhamadi Narimane , Blesboi Véléda , Delon Marie , Ep Alexia , Mahmoudi Kaïna , Ledra Katia , Garcia Ramos Irène , Henault Marie , Dantigny Alexia , Kone Aichetou , Firoud Djouher , Scialo Federica , Pignot Véronique , Drouet Elodie , Nubret Eunice , Bobin Margot , Aucan Christophe , Demerville Lauren , Bureau Serge , Preston Sarah , Simula Maria , Chew Derek , Sharma Yogesh , Aravind Asha , Hincks Christine , Hunt Ivana , Thomas Simeoni , Wollaston Fiona , Bertolet Marnie , Herbert Brandon , Kelsey Sheryl , Lombardero Manuel , Mercurio Rocco , Portela Gerard , Stevenson Jennifer , Stoliker Donna , Zadorozny Ella , Eckstein Jane F. , Glynn Simone , Leifer Eric , Smith Erin , Sopko George , Tonkins Phil , Cure Pablo , Levy Catherine , Luban Naomi , Konkle Barbara , Bhatt Deepak , Hod Eldad , Josephson Cassandra , Kim KyungMann , Lee Agnes , Serchuck Leslie , Stone Peter , Thompson Darby , Weise Kathryn 
Published: November 2024

Importance

In patients with acute myocardial infarction (MI), limited physiologic adaptation to acute anemia might lead to greater benefit from a liberal red blood cell (RBC) transfusion strategy. Data on such a possible benefit are lacking.

Objectives

To compare acute anemia with chronic anemia and post-MI outcomes and estimate the differential effect of a restrictive RBC transfusion strategy compared with a liberal strategy on post-MI outcomes according to anemia acuity.

Design, Setting, and Participants

A prespecified subgroup analysis of the Myocardial Ischemia and Transfusion (MINT) multicenter randomized clinical trial was conducted in 126 hospitals in 6 countries between April 26, 2017, and April 14, 2023, with 30-day follow-up and blinded adjudication of the primary outcome. The analysis included 3144 of 3504 MINT participants (89.7%) with acute MI, a hemoglobin (Hb) level less than 10 g/dL at randomization, and a first Hb measurement available on the day of or the day following hospital admission.

Intervention

The MINT trial randomized participants to a restrictive (Hb &amp;lt;7-8 g/dL) or liberal (Hb &amp;lt;10 g/dL) RBC transfusion strategy. Acute anemia was defined as having a first Hb value greater than 13 g/dL (men) or 12 g/dL (women), or as having a decrease greater than or equal to 2 g/dL between the first Hb measurement and measurement at randomization. Other Hb levels were categorized as chronic anemia.

Main Outcomes and Measures

The primary outcome was a composite of death or recurrent MI up to 30 days after randomization. Secondary outcomes were death, recurrent MI, cardiac death, heart failure, pulmonary complications, and major bleeding events. Intention-to-treat analysis was performed.

Results

Among 3144 included participants (mean [SD] age, 72.3 [11.6] years; 1715 [54.5%] male; 1307 [41.6%] with type 1 MI), 1078 [34.3%]) had acute anemia. Acute anemia was associated with an increased risk of death or recurrent MI (adjusted risk ratio, 1.25; 95% CI, 1.05-1.48). The effect of a restrictive RBC transfusion strategy compared with a liberal strategy was similar for participants with either acute or chronic anemia for all outcomes.

Conclusions and Relevance

In this secondary analysis of the MINT trial, acute anemia was associated with less favorable post-MI outcomes than chronic anemia but did not modify the effects of the randomized transfusion strategy. In patients with anemia and MI, the acuity of anemia should not influence the choice of transfusion trigger.

Trial Registration

ClinicalTrials.gov Identifier: NCT02981407