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. Dawn , Franchetti Kelly , Gordon Catherine , Aronow Herbert , Cerullo Ellen , Desimone Lori-Ann , Nowak Elizabeth , Coccio Elizabeth , Ramanathan Kodangudi , Adeboye Adedayo , Armstrong Ashley , Johnson Lillie , Pham Anh-Phuong , Shah Rahman , Schmidhofer Mark , Albright Mary Jo , Enlow Melissa , Hansra Barinder , Nicholson Tracy , Toma Catalin , Triulzi Darrell , Basch Megan , Bernardini Gretchen , Bollino Amanda , Dennis Laurie , Puntil Kathy , Snyder Chelsey , Spearman Linda , Whitehead Jenny , Keating Friederike , Harchandani Bhisham , Sesera Meghan , Halevy Jonathan , Raftery Molly , Roth Marilynn , Kountz David , Carson Michael , Argenzio Lynda , Kontos Michael , Sears Melissa , Johnson Laura , Qureshi Mansoor , Mizyed Ahmad , Whitsett Sarah , Wippler Kristina , Raval Jay , Clegg Stacey , Laskey Warren , Mondragon Judith , Polonsky Tamar , Carlson Matthew , Drovetsky Catherine , Gutbrod Joseph , Prochaska Micah , Jansen Maud , Jeyaram Tharani , Reffat Noora , Gupta Rajesh , Sheikh Mujeeb A. , (Redd) Moore Meghan , Fisher Kristin , Gilmore Jennifer , Sattler Christina , Frank Stephanie , Uhl Lynne , Ho Kalon , Hunsaker Hannah , Kaufman Jenifer , Lanuto Lauren , Strom Jordan , Tyler Patricia , Mullen Paul , Ratcliffe Jennifer , Williams Brandy , Bracey Arthur , Boan Araceli , De Freitas Gilberto , Macias Samantha , Younis George , Matthai William , Khandhar Sameer , Maslowski Karen , Patel Nilay , Elmariah Sammy , Stowell Christopher , Dudzinski David , Abou-Karam Roukoz , Fu Lina , Jamiel Paris , Brueggeman Cristina , Marhefka Gregary , Cain Blaire , Gallagher Barbara , Weinstock Perry , Aji Janah , Corbett Brian , Iliadis Elias , Niblack Patricia , Ogbara Jeffrey , Topalian Simon , Abreu Leana , Logan Amanda , Salvatore Amanda , Siderio Erin , Lawson William , Stein Ruth J. , Weber-Fishkin Samantha , Keller Norma , Yuriditsky Eugene , Alviar Carlos L. , Bangalore Sripal , Daly Maria , Sivakumaran Dharshini , Dwyer Raven , Rodriguez Alvarez Carolina , Ahmad Shuaib , Thomas Michael , Schley Allison , Vue Gau Shoua , Hochberg Claudia , Siddiqi Omar , Fine Denise , Jacobs Alice , Schulman-Marcus Joshua , Torosoff Mikhail , Stewart Wendy , Gitter Michael , Shimada-Krouwer Barbara , Harmann Leanne , Karafin Matthew , Patlolla Pranitha , Werra Julie , Wexler Mary , Dai Xuming , Ng Jackson , Adam Asif , Cherian Ajini , Traverse Jay , Benson Carina , Peterson Rose , McMeans Amy , Reedy Elizabeth , Sarafolean Andrea , McCamant Eric , Scott Jason , Jordan Michelle , Knepper Kay , Nguyen Jennifer , Ramsey Deborah , Tawil Tara , Wood Todd , Dave Dhvni , Testa Heidi , Swaminathan Rajesh , Rao Sunil , Aristy Kathy , Krucoff Mitchell , Povsic Thomas , Goldsweig Andrew M. , Malik Shahbaz , Chatzizisis Yiannis , Higgins John , Velagapudi Poonam , Barton David , Stone Jeremy , Sayyed Samer , Jhand Arav , Johnson Daniel , Sullivan James , Khattak Furquan , Stout Kara , Nickol Jennifer , Shin David , Oberoi Mansi , Johnson Taylor , Howard Melissa , Starfeldt Zaria , Ruskamp Ryan , Muhn Nathan , Pacheco Camila , Patterson Tyler , Adler Angie , DeFilippis Andrew P. , Lidani Karita , Reynolds Cassandra , Brooks Nicholas , Bierenga Stephan , Salisbury Adam C. , Hall Jamie , Landers David , Hendel Robert , Ginete Wilson , Raveendran Ganesh , Hudak Craig , Ebrahimi Ramin , Bach Richard , Palazzolo Margie , Striler Kimberly , Mascari Paolo , Wasserman Hal , Delehanty Joseph , Shah Raj C. , Schmaltz Lesley A. , Attanasio Steve , Brener Sorin , Duffy Brendan , Grunenwald Paul , Doroshow Jonathan , Shakir Muhammad Abubakar , Caixeta Adriano , Galhardo Attilio , Santiago Teixeira Paula , Umbelino S. 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 , Silva Maria Cleide Freire Clementino , Tavares De Carvalho Osmário , De Moura Monteiro Júnior José Gildo , Nascimento Sergio , De Martino Fernando , Camasmie Paula M. , Castanho Da Rocha Leonilda , De Oliveira Assunção Pâmela Joice R. , Rodrigues de Oliveira Fábio , Vilela Paulo H.M. , de Sousa Rodrigo Cunha , Figueiredo Estevão L. , Neuenschwander Fernando Carvalho , Neuenschwander Cristina Carvalho , Falco Izabela R. , Matos Arlete , Huynh Thao , Fuentes Nancy , Barnett Amanda , Boudreault Caroline , Schnell Greg , Poirier Leslie , Ramadan Darlene , Senaratne Manohara , Fernando Bernadette , Hanninen Mike , Jayasekara Anushka , Senaratne Janek , Coonghe Lalantha , Manchikanti Sharada , Nanayakkara Gamintha , Tandon Vikas , Power Patricia , Proc Ryan , Srivaratharajah Kajenny , Trombetta Lisa , Mendoza Pablo , Gregus Krysten , Hare Jacqueline , Lawrence Kelly , Patel Ameen , Pettit Shirley , Kuber Jocelyn , Nasr Summer , Neary John , Abdulrahman Muammar , Cohen David , El Dahr Yola , 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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

ImportanceIn 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.ObjectivesTo 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 ParticipantsA 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.InterventionThe 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 MeasuresThe 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.ResultsAmong 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 RelevanceIn 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 RegistrationClinicalTrials.gov Identifier: NCT02981407