Effect of Four Hemoglobin Transfusion Threshold Strategies in Patients With Acute Myocardial Infarction and Anemia
Authors: Gerard T. Portela, Jeffrey L. Carson, Sonja A. Swanson, John H. Alexander, Paul C. Hébert, Shaun G. Goodman, Philippe Gabriel Steg, Marnie Bertolet, Jordan B. Strom, Dean A. Fergusson, Tabassome Simon, Harvey D. White, Howard A. Cooper, J. Dawn Abbott, Sunil V. Rao, Bernard R. Chaitman, Christopher B. Fordyce, Renato D. Lopes, Benoit Daneault, Maria M. Brooks, Adam C. Salisbury, Adam Gershon, Adedayo Adeboye, Adriana Carbonaro, Adriano Caixeta, Aglae Garvey Rene, Agnes Lee, Ahmad Mizyed, Ahmed Hassanin, Aichetou Kone, Ajini Cherian, Akshay Bagai, Alana Gulliver, Aleisha Easton, Alexandra Rousseau, Alexandre Gautier, Alexandre Quadros, Alexia Dantigny, Alexia Ep, Ali Ghamraoui, Alice Jacobs, Aline Giacomo, Allison Schley, Amanda Barnett, Amanda Bollino, Amanda Logan, Amanda Salvatore, Amanda Tice, Amandine Grelier, Amandine Ruissel, Ameen Patel, Ami Patel, Amina Zamiti-Smondel, Amy McMeans, Andrea Sarafolean, Andrew Baker, Andrew M. Goldsweig, Andrew P. DeFilippis, Andrew Starovoytov, Angeline Camilo, Angélique Andrieu, Angie Adler, Anh-Phuong Pham, Anna Helena Felipe Pereira Centurione, Anna Koulova, Anna Law, Anna Tran, Anne Druart, Antoine Fayol, Antoine Lequipar, Anuritha Tirumani, Anushka Jayasekara, Araceli Boan, Arav Jhand, Ariel Diaz, Arlete Matos, Arnaud Ferrante, Arthur Bracey, Arthur Darmon, Arthur Ramonatxo, Asha Aravind, Asha Mellor, Ashley Armstrong, Asif Adam, Ata Ur Rehman Quraishi, Attilio Galhardo, Audrey Cailliau, Aurelie Gutehrle, Axelle Fuentes, Barbara Gallagher, Barbara Konkle, Barbara Shannon, Barbara Shimada-Krouwer, Barinder Hansra, Barry Kaplan, Barry Uretsky, Basile Verdier, Batric Popovic, Baya Mahtout, Behram Mody, Benoit Daneault, Benoit Lattuca, Bernadette Fernando, Bernard Kadosh, Bernard R. Chaitman, Bhisham Harchandani, Blaire Cain, Brandon Dilluvio, Brandon Herbert, Brandy Williams, Brendan Duffy, Brian Corbett, Brian J. Potter, Bruna Machado, Bryan Marais, Camila Pacheco, Camila Richter, Camilla Vieira, Camille Correia, Camille Granger, Carina Benson, Carl Reimers, Carl-Éric Gagné, Carlos A K Nakashima, Carlos L. Alviar, Carlos Rochitti, Carolina Rodriguez Alvarez, Caroline Alsweiler, Caroline Boudreault, Caroline Vallières, Carolyn Jackson, Cassandra Josephson, Cassandra Reynolds, Cassie Wagner, Catalin Toma, Catherine Bouffard, Catherine Cruickshank, Catherine Drovetsky, Catherine Gordon, Catherine Levy, Cathrine Patten, Cathy Vickers, Celine Boucher, Celine Yan, Charlotte McNab, Charmaine Dias, Chelsey Snyder, Chloé Bonneton, Christel Simard, Christel Vassaliere, Christina Avena-Cyr, Christina Sattler, Christine Hincks, Christophe Aucan, Christophe Thuaire, Christophe Tron, Christopher Fordyce, Christopher Stowell, Chuen Siang Low, Cindy Prié, Claire Bouleti, Claire Marie Pedroso Dias Corsini, Claire Vezier, Claudia Eaton, Claudia Hochberg, Claudine Robert, Clémence Charlon, Clément Servoz, Coralie Gasc, Corine Thobois, Craig Basman, Craig Hudak, Cristina Brueggeman, Cristina Carvalho Neuenshwander, Cristina Correa, Dalton Precoma, Danica Kistanna, Daniel Johnson, Danieli Frassatto, Darby Thompson, Dário Celestino Sobral Filho, Darlene Ramadan, Darrell J. Triulzi, Darrell Triulzi, David Barton, David Brieger, David Cohen, David Dudzinski, David Fillmore, David Kountz, David Laflamme, David Landers, David Shin, Dean A. Fergusson, Deanna Ravenscraft, Deborah Keller, Deborah McCloskey, Deborah Ramsey, Deepak Bhatt, Delphine Beziau-Gasnier, Denis Angoulvant, Denise Fine, Derek Chew, Dharshini Sivakumaran, Dhvni Dave, Diana Albers, Diana Gatland, Dinesh Kalra, Djedjiga Naudin, Djouher Firoud, Donna Stoliker, Doreen Singh, Dounia Boumahni, Eldad Hod, Eliane Sehnem, Elias Iliadis, Elizabeth Coccio, Elizabeth Martin, Elizabeth Nowak, Elizabeth Reedy, Ella Zadorozny, Ellen Cerullo, Elodie Delelo, Elodie Drouet, Emile Ferrari, Emilie Collet, Emilie Sau, Emilie Tachot, Emily Pierce, Emily Strober, Emma Kleemann, Emma Reynolds, Eric Durand, Eric Leifer, Eric McCamant, Erin Morton, Erin Siderio, Erin Smith, Ervin Mazniku, Estefania Hernandez, Estevão Lanna Figueiredo, Etienne Fourrier, Etienne Puymirat, Eugene Yuriditsky, Eunice Nubret, Fabien Huet, Fábio Rodrigues de Oliveira, Fabrice Ivanes, Faraaz Quraishi, Farhad Abtahian, Fatemeh Vaezi-Poor, Fatima Benattia, Fatna Benettaib, Federica Scialo Véronique Pignot, Fei Chen, Fernando Carvalho Neuenschwander, Fernando De Martino, Fiona Wollaston, Florence Bichat, Fnu Namrata, Frances Wood, Francisco Campelo-Parada, François Martin Carrier, François Roubille, Frédéric Bouisset, Frederico Toledo Campo Dall’Orto, Friederike Keating, Furquan Khattak, Gabriela De Jesus, Gaetana Cosentino, Gamintha Nanayakkara, Ganesh Raveendran, Gau Shoua Vue, Gautier Desmoulin, Genevieve Dallaire, George Sopko, George Younis, Georgia Beatriz Oliveira Damásio, Gérald Vanzetto, Geraldine Ricafort, Gerard Portela, Gilberto De Freitas, Gilles Barone Rochette, Gilles Lemesle, Gislayne Rogante Ribeiro, Giulia Bonatto, Graham Hillis, Greg Schnell, Gregary Marhefka, Gregory Barsness, Gregory Ducrocq, Gregory Maniatis, Gretchen Bernardini, Gyan Sandhu, Hal Wasserman, Hannah Hunsaker, Hardeep Dholiya, Harsha Adnani, Harvey White, Hasina Rakotosamimanana, Heidi Testa, Helaine Noveck, Hélène Abergel, Herbert Aronow, Himantha De Silva, Hinde Irekti, Hope Wolf, Houda El Banna, Howard A. Cooper, Hussein Beydoun, Ian Crozier, Ian Dalangin, Ian Ternouth, Imants Rubenis, Imrana Khalid, Irène Garcia Ramos, Isabelle Chausse, Isabelle Pilat, Isabelle Roy, Israel Cabral, Ivana Hunt, Izabela Rodarte Falco, J. Dawn Abbott, Jackie Chow, Jackson Ng, Jacob Jentzer, Jacqueline Hare, Jae Sung Lee, James Sullivan, Jamie Hall, Jan Friedrich, Janah Aji, Jane F. Eckstein, Janek Senaratne, Janet Bogan, Jasjit Bhinder, Jason Scott, Javier Molina-Martin De Nicolas, Jay Raval, Jay Traverse, Jayakumar Sreenivasan, Jean Guillaume Dillinger, Jean-François Naud, Jeanne Varlot, Jean-Pierre Dery, Jeffrey L. Carson, Jeffrey Ogbara, Jenifer Kaufman, Jennifer Gilmore, Jennifer LaLonde, Jennifer Moore, Jennifer Nguyen, Jennifer Nickol, Jennifer Ratcliffe, Jennifer Stevenson, Jenny Petterson, Jenny Whitehead, Jeremy Stone, Jesse Byrd, Jessica Breistroff, Jéssica Ribeiro, Jette Koelle, Jithendra Somaratne, Jocelyn Kuber, Jocelyne Benatar, Johanne Silvain, John Ducas, John Elliott, John Graham, John H. Alexander, John Higgins, John Neary, Jonathan Doroshow, Jonathan Halevy, Jordan Strom, José Gildo De Moura Monteiro Júnior, Joseph Delehanty, Joseph Gutbrod, Joseph Rossi, Joshua Roark, Joshua Schulman-Marcus, Joyce Umbelino S. Yamamoto, Judah Rauch, Judith Mondragon, Jules Mesnier, Julia Hoang, Juliana Vieira Garcia, Juliane Posson, Julie Caron, Julie Hildt, Julie Werra, Kaïna Mahmoudi, Kaitlyn Sternat, Kajenny Srivaratharajah, Kalon Ho, Kara Stout, Karen Dragert, Karen duBourg, Karen Maslowski, Karina De Carvalho Cordeiro, Karita Lidani, Katherine Coutu-Beaudry, Kathryn Weise, Kathy Aristy, Kathy Puntil, Katia Lassouani, Katia Ledra, Kay Knepper, Kayla Malchoff, Kellie Sherron, Kelly Franchetti, Kelly Lawrence, Kelly Mohr, Kemilys Marine Ferreira, Kevin Bainey, Kim Allen, Kimberly Lemoine, Kimberly Striler, Kiran Atwal, Kodangudi Ramanathan, Kristie Coleman, Kristin Fisher, Kristin Miller, Kristina Wippler, Krysten Gregus, Kunal Minhas, Kyle Agostini, KyungMann Kim, Lalantha Coonghe, LaMonica Daniel, Larissa Teixeira Aleixo Silva, Laura Cetran, Laura Johnson, Laura Tomat, Lauren Demerville, Lauren Lanuto, Laurence Berard, Laurent Delorme, Laurie Dennis, Lea Cacoub, Leana Abreu, Leanne Harmann, Leonilda Castanho Da Rocha, Lesley A. Schmaltz, Leslie Poirier, Leslie Serchuck, Lília Nigro Maia, Lilian Mazza Barbosa, Liliane A.T. Arnaldi Seixas, Lillie Johnson, Lily Cai, Lina Fu, Linda Spearman, Lisa Trombetta, Lise Blais, Lori-Ann Desimone, Lorraine Hillis, Loukas Boutis, Luis Gruberg, Luiz Eduardo Fontelles Ritt, Lynda Argenzio, Lynne Uhl, Mailis Saint-Jalmes, Malek Kass, Mallory Hatfield, Manohara Senaratne, Mansi Oberoi, Mansoor Qureshi, Manuel Lombardero, Marcelo Nakazone, Margie Palazzolo, Margot Bobin, Maria Angélica Lemos, Maria Cleide Freire Clementino Silva, Maria Daly, Maria Masih, Maria Mori Brooks, Maria Simula, Mariana Lopes, Marianna Dracoulakis, Marie Delon, Marie Henault, Marilynn Roth, Marina Leniliot, Marine Poisay, Marine Servat, Marion Berous, Mark Menegus, Mark Schmidhofer, Marlene Santos, Marnie Bertolet, Martin Faucher, Martine Lebrasseur, Mary Jo Albright, Mary Wexler, Matt Cavender, Matthew Carlson, Matthew Karafin, Maud Jansen, Maximilien Saint-Gilles, Maya Hatwik, Maynara Martins, Meechai Tessalee, Megan Basch, Megan Gonzalez, Megan Littleton, Meghan (Redd) Moore, Meghan Sesera, Melanie Roy, Melissa Enlow, Mélissa Gagnon-Hamelin, Melissa Howard, Melissa Sears, Mélissa Sriwaran, Meriton Ruhani, Micah Prochaska, Michael Carson, Michael Gitter, Michael Goldfarb, Michael Hume, Michael Kontos, Michael Kutryk, Michael Thomas, Michel Zeitouni, Micheline Charron, Micheline Nantel, Michelle Bonner, Michelle Jordan, Miguel Barrero, Mike Hanninen, Mikhail Torosoff, Mina Madan, Miriam Schnorr Meloche, Mitchell Krucoff, Mohamed Labbaoui, Mohammed Hasan Khan, Mohammed Mouzouri, Mollie Machado, Molly Raftery, Mona Doorsian, Mouin Nasr, Muammar Abdulrahman, Muhammad Abubakar Shakir, Muhammad Iqbal, Mujeeb Abdul Sheikh, Nadhira Bennacer, Nadielly Prado, Najime Bouhzam, Nancy Fuentes, Naomi Luban, Naomi Uchida, Narimane Benhamadi, Nassim Redjimi, Natalia Alvaia, Natalia Cordeiro da Silva, Nathalie Berger, Nathalie Durand, Nathan Muhn, Neelam Dalman, Neil Brass, Neil Fam, Neila Sayah, Nesrine Hafsi, Ngaire Meadows, Nicholas Brooks, Nick Bartlett, Nick Fisher, Nicolas Michaud, Nicolas Pham, Nidhya Lakshmi Thulasiraj, Nikki Procopi, Nilay Patel, Noelle Manning, Noora Reffat, Norberto Garcia, Noreen Lounsbury, Norma Hogg, Norma Keller, Océane Crebier, Odilis Ramirez, Olivia Bogdan, Olivier Barthelemy, Omar Siddiqi, Oreyane Tate, Osana Costa, Osmário Tavares De Carvalho, Osvaldo Da Silva Júnior, Pablo Cure, Pablo Mendoza, Pâmela Joice Ribeiro De Oliveira Assunção, Paola Engelmann Arantes, Paolo Mascari, Parija Sharedalal, Paris Jamiel, Pascale Léon, Patricia Niblack, Patricia Power, Patricia Tyler, Patrick Desanto, Patty Noll, Paul C. Hébert, Paul Grunenwald, Paul Mullen, Paula Miranda Camasmie, Paula Santiago Teixeira, Pauline Peretout, Paulo Henrique Maia Vilela, Paulo Jhones Dutra, Payam Dehghani, Pedro Beraldo De Andrade, Pedro de Barros e Silva, Pedro Gabriel Melo de Barros e Silva, Perrine Devos, Perry Weinstock, Perwaiz Meraj, Peter Stone, Phil Tonkins, Philippe Gabriel Steg, Philippe Rheault, Pierre Coste, Poonam Velagapudi, Pranitha Patlolla, Puneet Gandotra, Queila Borges De Oliveira, Quentin Fischer, Rabab Bencherif, Rachel Elysee, Rachel Gentles, Rahman Shah, Raj C. Shah, Rajesh Gupta, Rajesh Swaminathan, Rajiv Jauhar, Ramin Ebrahimi, Raphael Guimarães, Raven Dwyer, Razi Khan, Rebecca Cairns, Rehana Bajwa, Reilly Ische, Renato D. Lopes, Renée Duclos, Reza Sahebjamei, Rhonda Norton, Ricardo Costa, Ricardo Reinaldo Bergo, Richard Bach, Richard Dima, Richard Haichin, Riona Timmons, Risheek Kaul, Robert Hendel, Robert Roswell, Robson Alves Barbosa, Rocco Mercurio, Rodolfo Dourado, Rodrigo Cunha de Sousa, Romain André, Roman Royzman, Rose Peterson, Roukoz Abou-Karam, Ruth J. Stein, Ryan Orgel, Ryan Proc, Ryan Ruskamp, Sabiha Sultana, Samanta Baboolall, Samantha Macias, Samantha Smith, Samantha Weber-Fishkin, Sameer Khandhar, Samer Sayyed, Samia Tamazi, Sammy Elmariah, Samraj Nandra, Sandra Kahlouche, Sandra Paco, Sara Blanc Vannet, Sara Jabeen, Sarah Arab, Sarah Hadjih, Sarah Preston, Sarah Whitsett, Sarang Kim, Sean Taylor, Serge Bureau, Sergio Nascimento, Shahab Ghafghazi, Shahab Pathan, Shahbaz Malik, Sharada Manchikanti, Sharon Vincent, Shaun G. Goodman, Sheila Davila, Sheila Redding, Sheryl Kelsey, Sheryll Sorensen, Shirley Lim, Shirley Pettit, Shuaib Ahmad, Sidney Gomes, Silvia Poleth, Simeoni Thomas, Simon Kirkham, Simon Robinson, Simon Topalian, Simone Glynn, Sohaib Virk, Solenn Catherine, Sonia Azzakani, Sophie Florencio, Soraya Merbah, Sorin Brener, Spencer Wikkerink, Srikanth Vallurupalli, Sripal Bangalore, Stacey Clegg, Stella Chan, Stephan Bierenga, Stéphane Manzo-Silberman, Stephanie Frank, Stéphanie Marliere, Stéphanie Tribeau, Stephen Allan Schaffer, Steve Attanasio, Su Swe, Summer Nasr, Suneet Khurana, Sunil Rao, Sunil Rao, Susan Vallancey, Suzanne Welshsan, Sydney Thorsteinsson, Syed Haidry, Tabassome Simon, Taís Sarmento, Tamar Polonsky, Tara Tawil, Tatum Scholl, Taylor Johnson, Teresa Reed, Terry McPherson, Thaise Loverdi, Thao Huynh, Tharani Jeyaram, Thibaud Genet, Thibault Lhermusier, Thibaut Hemery, Thomas Baudinet, Thomas Povsic, Thomas Wallet, Tia Albro, Todd Wood, Tomy Salloum, Tracy Nicholson, Tyler Patterson, Tyrone Wade, Umar Rashid, Véléda Blesboi, Veronica Day, Victor Buzura, Victoria Tea, Vikas Tandon, Vincent Spagnoli, Vladimír Džavík, Warren Laskey, Wendy Stewart, William J. Kostis, William Lawson, William Matthai, Wilson Ginete, Xuming Dai, Yanek Pépin-Dubois, Yann Rosamel, Yiannis Chatzizisis, Ying Tung Sia, Yogesh Sharma, Yogita Rochlani, Yola El Dahr, Yves Cottin, Zaria Starfeldt
Journal: Annals of Internal Medicine (2024)

The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain. To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia. Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods. (ClinicalTrials.gov: NCT02981407). 144 clinical sites in 6 countries. 3492 MINT trial participants with acute MI and a hemoglobin level below 10 g/dL. Four transfusion strategies to maintain patients' hemoglobin concentrations at or above thresholds of 10, 9, 8, or 7 g/dL. Protocol exceptions were permitted for specified adverse clinical events. Data from the MINT trial were leveraged to emulate 4 transfusion strategies and estimate per protocol effects on the composite outcome of 30-day death or recurrent MI (death/MI) and 30-day death using inverse probability weighting. The 30-day risk for death/MI was 14.8% (95% CI, 11.8% to 18.4%) for a <10-g/dL strategy, 15.1% (CI, 11.7% to 18.2%) for a <9-g/dL strategy, 15.9% (CI, 12.4% to 19.0%) for a <8-g/dL strategy, and 18.3% (CI, 14.6% to 22.0%) for a <7-g/dL strategy. Absolute risk differences and risk ratios relative to the <10-g/dL strategy for 30-day death/MI increased as thresholds decreased, although 95% CIs were wide. Findings were similar and imprecise for 30-day death. Unmeasured confounding may have persisted despite adjustment. The 30-day risks for death/MI and death among patients with acute MI and anemia seem to increase progressively with lower hemoglobin concentration thresholds for transfusion. However, the imprecision around estimates from this target trial analysis precludes definitive conclusions about individual hemoglobin thresholds. National Heart, Lung, and Blood Institute.