Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction
Authors: François M. Carrier, Howard A. Cooper, Gerard T. Portela, Marnie Bertolet, Gilles Lemesle, Micah Prochaska, Sarang Kim, John H. Alexander, Ian Crozier, Gregory Ducrocq, Alexandre S. Quadros, Akshay Bagai, Marianna Dracoulakis, Mina Madan, Maria M. Brooks, Jeffrey L. Carson, Paul C. Hébert, Jeffrey L. Carson, Fei Chen, Patrick Desanto, Karen Dragert, William J. Kostis, Sarang Kim, Deborah McCloskey, Helaine Noveck, Sheila Redding, Ami Patel, Shahab Ghafghazi, Sharon Vincent, Hardeep Dholiya, Dinesh Kalra, Jennifer Moore, Mallory Hatfield, Howard A. Cooper, Syed Haidry, Ahmed Hassanin, Risheek Kaul, Fnu Namrata, Parija Sharedalal, Jayakumar Sreenivasan, Jasjit Bhinder, Mohammed Hasan Khan, Anna Koulova, Behram Mody, Yogita Rochlani, Anuritha Tirumani, Frances Wood, Rhonda Norton, LaMonica Daniel, Mark Menegus, Samanta Baboolall, Sheila Davila, Noelle Manning, Mollie Machado, Judah Rauch, Angeline Camilo, Estefania Hernandez, Muhammad Iqbal, Ervin Mazniku, Odilis Ramirez, Veronica Day, Barry Uretsky, Jesse Byrd, Kristin Miller, Srikanth Vallurupalli, Gregory Maniatis, Richard Dima, Roman Royzman, Sean Taylor, Amanda Tice, Brandon Dilluvio, Luis Gruberg, Puneet Gandotra, Rachel Gentles, Barbara Shannon, Maria Masih, Robert Roswell, Alana Gulliver, Meriton Ruhani, Emily Strober, Samia Tamazi, Adam Gershon, Kristie Coleman, Bernard Kadosh, Rajiv Jauhar, Harsha Adnani, Kyle Agostini, Loukas Boutis, Ian Dalangin, Barry Kaplan, Jae S. Lee, Perwaiz Meraj, Riona Timmons, Carl Reimers, Craig Basman, Umar Rashid, Aglae Garvey Rene, Asha Mellor, Karen duBourg, Joseph Rossi, Ryan Orgel, Emma Reynolds, Tatum Scholl, Janet Bogan, Olivia Bogdan, Matt Cavender, Gaetana Cosentino, Gabriela De Jesus, Megan Gonzalez, Julia Hoang, Emma Kleemann, Deanna Ravenscraft, Teresa Reed, Joshua Roark, Samantha Smith, Kaitlyn Sternat, Oreyane Tate, Tyrone Wade, Hope Wolf, Farhad Abtahian, Megan Littleton, Kayla Malchoff, Kelly Mohr, Emily Pierce, Jennifer LaLonde, Kellie Sherron, Tia Albro, Patty Noll, Meechai Tessalee, Claudia Eaton, Gregory Barsness, Diana Albers, Jacob Jentzer, J. Dawn Abbott, Kelly Franchetti, Catherine Gordon, Herbert Aronow, Ellen Cerullo, Lori-Ann Desimone, Elizabeth Nowak, Elizabeth Coccio, Kodangudi Ramanathan, Adedayo Adeboye, Ashley Armstrong, Lillie Johnson, Anh-Phuong Pham, Rahman Shah, Mark Schmidhofer, Mary Jo Albright, Melissa Enlow, Barinder Hansra, Tracy Nicholson, Catalin Toma, Darrell Triulzi, Megan Basch, Gretchen Bernardini, Amanda Bollino, Laurie Dennis, Kathy Puntil, Chelsey Snyder, Linda Spearman, Jenny Whitehead, Friederike Keating, Bhisham Harchandani, Meghan Sesera, Jonathan Halevy, Molly Raftery, Marilynn Roth, David Kountz, Michael Carson, Lynda Argenzio, Michael Kontos, Melissa Sears, Laura Johnson, Mansoor Qureshi, Ahmad Mizyed, Sarah Whitsett, Kristina Wippler, Jay Raval, Stacey Clegg, Warren Laskey, Judith Mondragon, Tamar Polonsky, Matthew Carlson, Catherine Drovetsky, Joseph Gutbrod, Micah Prochaska, Maud Jansen, Tharani Jeyaram, Noora Reffat, Rajesh Gupta, Mujeeb A. Sheikh, Meghan (Redd) Moore, Kristin Fisher, Jennifer Gilmore, Christina Sattler, Stephanie Frank, Lynne Uhl, Kalon Ho, Hannah Hunsaker, Jenifer Kaufman, Lauren Lanuto, Jordan Strom, Patricia Tyler, Paul Mullen, Jennifer Ratcliffe, Brandy Williams, Arthur Bracey, Araceli Boan, Gilberto De Freitas, Samantha Macias, George Younis, William Matthai, Sameer Khandhar, Karen Maslowski, Nilay Patel, Sammy Elmariah, Christopher Stowell, David Dudzinski, Roukoz Abou-Karam, Lina Fu, Paris Jamiel, Cristina Brueggeman, Gregary Marhefka, Blaire Cain, Barbara Gallagher, Perry Weinstock, Janah Aji, Brian Corbett, Elias Iliadis, Patricia Niblack, Jeffrey Ogbara, Simon Topalian, Leana Abreu, Amanda Logan, Amanda Salvatore, Erin Siderio, William Lawson, Ruth J. Stein, Samantha Weber-Fishkin, Norma Keller, Eugene Yuriditsky, Carlos L. Alviar, Sripal Bangalore, Maria Daly, Dharshini Sivakumaran, Raven Dwyer, Carolina Rodriguez Alvarez, Shuaib Ahmad, Michael Thomas, Allison Schley, Gau Shoua Vue, Claudia Hochberg, Omar Siddiqi, Denise Fine, Alice Jacobs, Joshua Schulman-Marcus, Mikhail Torosoff, Wendy Stewart, Michael Gitter, Barbara Shimada-Krouwer, Leanne Harmann, Matthew Karafin, Pranitha Patlolla, Julie Werra, Mary Wexler, Xuming Dai, Jackson Ng, Asif Adam, Ajini Cherian, Jay Traverse, Carina Benson, Rose Peterson, Amy McMeans, Elizabeth Reedy, Andrea Sarafolean, Eric McCamant, Jason Scott, Michelle Jordan, Kay Knepper, Jennifer Nguyen, Deborah Ramsey, Tara Tawil, Todd Wood, Dhvni Dave, Heidi Testa, Rajesh Swaminathan, Sunil Rao, Kathy Aristy, Mitchell Krucoff, Thomas Povsic, Andrew M. Goldsweig, Shahbaz Malik, Yiannis Chatzizisis, John Higgins, Poonam Velagapudi, David Barton, Jeremy Stone, Samer Sayyed, Arav Jhand, Daniel Johnson, James Sullivan, Furquan Khattak, Kara Stout, Jennifer Nickol, David Shin, Mansi Oberoi, Taylor Johnson, Melissa Howard, Zaria Starfeldt, Ryan Ruskamp, Nathan Muhn, Camila Pacheco, Tyler Patterson, Angie Adler, Andrew P. DeFilippis, Karita Lidani, Cassandra Reynolds, Nicholas Brooks, Stephan Bierenga, Adam C. Salisbury, Jamie Hall, David Landers, Robert Hendel, Wilson Ginete, Ganesh Raveendran, Craig Hudak, Ramin Ebrahimi, Richard Bach, Margie Palazzolo, Kimberly Striler, Paolo Mascari, Hal Wasserman, Joseph Delehanty, Raj C. Shah, Lesley A. Schmaltz, Steve Attanasio, Sorin Brener, Brendan Duffy, Paul Grunenwald, Jonathan Doroshow, Muhammad Abubakar Shakir, Adriano Caixeta, Attilio Galhardo, Paula Santiago Teixeira, Joyce Umbelino S. Yamamoto, Dalton Precoma, Cristina Correa, Maynara Martins, Carlos Rochitti, Camila Richter, Carlos A.K. Nakashima, Eliane Sehnem, Frederico Toledo Campo Dall’Orto, Gislayne Rogante Ribeiro, Ricardo Reinaldo Bergo, Claire Marie Pedroso Dias Corsini, Kemilys Marine Ferreira, Pedro B. De Andrade, Robson A. Barbosa, Marianna Dracoulakis, Natalia Alvaia, Rodolfo Dourado, Jéssica Ribeiro, Camilla Vieira, Taís Sarmento, Aline Giacomo, Mariana Lopes, Lília N. Maia, Osana Costa, Paulo Jhones Dutra, Danieli Frassatto, Juliana Vieira Garcia, Maria Angélica Lemos, Thaise Loverdi, Marcelo Nakazone, Nadielly Prado, Osvaldo Da Silva Júnior, Natalia Cordeiro da Silva, Sidney Gomes, Anna Helena Felipe Pereira Centurione, Luiz Eduardo Fontelles Ritt, Queila Borges De Oliveira, Karina De Carvalho Cordeiro, Alexandre Quadros, Giulia Bonatto, Bruna Machado, Silvia Poleth, Camille Correia, Raphael Guimarães, Israel Cabral, Dário Celestino Sobral Filho, Maria Cleide Freire Clementino Silva, Osmário Tavares De Carvalho, José Gildo De Moura Monteiro Júnior, Sergio Nascimento, Fernando De Martino, Paula M. Camasmie, Leonilda Castanho Da Rocha, Pâmela Joice R. De Oliveira Assunção, Fábio Rodrigues de Oliveira, Paulo H.M. Vilela, Rodrigo Cunha de Sousa, Estevão L. Figueiredo, Fernando Carvalho Neuenschwander, Cristina Carvalho Neuenschwander, Izabela R. Falco, Arlete Matos, Thao Huynh, Nancy Fuentes, Amanda Barnett, Caroline Boudreault, Greg Schnell, Leslie Poirier, Darlene Ramadan, Manohara Senaratne, Bernadette Fernando, Mike Hanninen, Anushka Jayasekara, Janek Senaratne, Lalantha Coonghe, Sharada Manchikanti, Gamintha Nanayakkara, Vikas Tandon, Patricia Power, Ryan Proc, Kajenny Srivaratharajah, Lisa Trombetta, Pablo Mendoza, Krysten Gregus, Jacqueline Hare, Kelly Lawrence, Ameen Patel, Shirley Pettit, Jocelyn Kuber, Summer Nasr, John Neary, Muammar Abdulrahman, David Cohen, Yola El Dahr, Faraaz Quraishi, Laura Tomat, Spencer Wikkerink, David Laflamme, Miriam Schnorr Meloche, Christel Simard, Lise Blais, Jean-Pierre Dery, Christina Avena-Cyr, Melanie Roy, Micheline Charron, Kevin Bainey, Norma Hogg, Suzanne Welshsan, Richard Haichin, Coralie Gasc, Reza Sahebjamei, Fatemeh Vaezi-Poor, Payam Dehghani, Sabiha Sultana, Ata Ur Rehman Quraishi, Hussein Beydoun, David Fillmore, Deborah Keller, Nick Bartlett, Brian J. Potter, François M. Carrier, Fatna Benettaib, Adriana Carbonaro, Isabelle Chausse, Katherine Coutu-Beaudry, Maya Hatwik, Martine Lebrasseur, Cindy Prié, Caroline Vallières, Dounia Boumahni, Genevieve Dallaire, Renée Duclos, Ali Ghamraoui, Mélissa Gagnon-Hamelin, Emilie Sau, Michael Goldfarb, Geraldine Ricafort, Claudine Robert, Sophie Florencio, Christopher Fordyce, Jackie Chow, Reilly Ische, Ngaire Meadows, Andrew Starovoytov, Sydney Thorsteinsson, Naomi Uchida, Lily Cai, Shirley Lim, Jenny Petterson, Himantha De Silva, Stella Chan, Celine Yan, Ying Tung Sia, Miguel Barrero, Ricardo Costa, Ariel Diaz, Martin Faucher, Carl-Éric Gagné, Jean-François Naud, Philippe Rheault, Yanek Pépin-Dubois, Vincent Spagnoli, Isabelle Roy, Benoit Daneault, Julie Caron, Mina Madan, Sara Jabeen, Nidhya Lakshmi Thulasiraj, Norberto Garcia, Suneet Khurana, Terry McPherson, Rehana Bajwa, Cassie Wagner, John Ducas, Kunal Minhas, Kiran Atwal, Malek Kass, Stephen Allan Schaffer, Neil Brass, Rebecca Cairns, Anna Law, Akshay Bagai, Mona Doorsian, Neil Fam, Jan Friedrich, Andrew Baker, John Graham, Michael Kutryk, Gyan Sandhu, Imrana Khalid, Marlene Santos, Simon Robinson, Kim Allen, Noreen Lounsbury, Sheryll Sorensen, Elizabeth Martin, Vladimír Džavík, Anna Tran, Razi Khan, Nicolas Michaud, Philippe Gabriel Steg, Gregory Ducrocq, Arthur Darmon, Quentin Fischer, Neila Sayah, Hélène Abergel, Catherine Bouffard, Audrey Cailliau, Axelle Fuentes, Nicolas Pham, Alexandre Gautier, Jules Mesnier, Etienne Puymirat, Mélissa Sriwaran, Rachel Elysee, Antoine Fayol, Amandine Grelier, Nesrine Hafsi, Hasina Rakotosamimanana, Victoria Tea, Sarah Arab, Hinde Irekti, Gilles Lemesle, Anne Druart, Isabelle Pilat, Basile Verdier, Emile Ferrari, Etienne Fourrier, Mohamed Labbaoui, Nassim Redjimi, Amina Zamiti-Smondel, Rabab Bencherif, Benoit Lattuca, Elodie Delelo, Johanne Silvain, Olivier Barthelemy, Fatima Benattia, Perrine Devos, Soraya Merbah, Juliane Posson, Nikki Procopi, Thomas Wallet, Michel Zeitouni, Arnaud Ferrante, Camille Granger, Stéphane Manzo-Silberman, Tomy Salloum, Gérald Vanzetto, Gilles Barone Rochette, Sara Blanc Vannet, Clémence Charlon, Océane Crebier, Stéphanie Marliere, Pauline Peretout, Julie Hildt, Laura Cetran, Thomas Baudinet, Pierre Coste, Amandine Ruissel, Marine Servat, Thibault Lhermusier, Frédéric Bouisset, Francisco Campelo-Parada, Kimberly Lemoine, Mouin Nasr, Marine Poisay, Clément Servoz, Stéphanie Tribeau, Yves Cottin, Florence Bichat, Mailis Saint-Jalmes, Victor Buzura, Yann Rosamel, Sarah Hadjih, Denis Angoulvant, Emilie Collet, Fabrice Ivanes, Katia Lassouani, Mohammed Mouzouri, Djedjiga Naudin, Thibaud Genet, Jean Guillaume Dillinger, Nadhira Bennacer, Lea Cacoub, Antoine Lequipar, Baya Mahtout, Christophe Thuaire, Marina Leniliot, Emilie Tachot, Corine Thobois, Christel Vassaliere, Batric Popovic, Jessica Breistroff, Aurelie Gutehrle, Maximilien Saint-Gilles, Jeanne Varlot, Eric Durand, Delphine Beziau-Gasnier, Najime Bouhzam, Solenn Catherine, Bryan Marais, Christophe Tron, Claire Vezier, Thibaut Hemery, Claire Bouleti, Arthur Ramonatxo, Sonia Azzakani, Nathalie Berger, Celine Boucher, François Roubille, Chloé Bonneton, Gautier Desmoulin, Fabien Huet, Sandra Kahlouche, Laurent Delorme, Angélique Andrieu, Javier Molina-Martin De Nicolas, Nathalie Durand, Marion Berous, Romain André, Ian Crozier, John Elliott, Catherine Cruickshank, Houda El Banna, Michael Hume, Jocelyne Benatar, Jithendra Somaratne, Diana Gatland, Danica Kistanna, Cathrine Patten, Doreen Singh, Samraj Nandra, Chuen Siang Low, Susan Vallancey, Ian Ternouth, Neelam Dalman, Aleisha Easton, Carolyn Jackson, Simon Kirkham, Cathy Vickers, Nick Fisher, Jette Koelle, Charlotte McNab, David Brieger, Shahab Pathan, Imants Rubenis, Su Swe, Sohaib Virk, Graham Hillis, Michelle Bonner, Charmaine Dias, Lorraine Hillis, Maria Mori Brooks, John H. Alexander, Shaun G. Goodman, Paul C. Hébert, Renato D. Lopes, Tabassome Simon, Harvey White, Caroline Alsweiler, Bernard R. Chaitman, Dean A. Fergusson, Erin Morton, Darrell J. Triulzi, Lilian Mazza Barbosa, Pedro Gabriel Melo de Barros e Silva, Liliane A T Arnaldi Seixas, Paola E. Arantes, Larissa Teixeira Aleixo Silva, Georgia Beatriz Oliveira Damásio, Laurence Berard, Alexandra Rousseau, Sandra Paco, Narimane Benhamadi, Véléda Blesboi, Marie Delon, Alexia Ep, Kaïna Mahmoudi, Katia Ledra, Irène Garcia Ramos, Marie Henault, Alexia Dantigny, Aichetou Kone, Djouher Firoud, Federica Scialo, Véronique Pignot, Elodie Drouet, Eunice Nubret, Margot Bobin, Christophe Aucan, Lauren Demerville, Serge Bureau, Sarah Preston, Maria Simula, Derek Chew, Yogesh Sharma, Asha Aravind, Christine Hincks, Ivana Hunt, Simeoni Thomas, Fiona Wollaston, Marnie Bertolet, Brandon Herbert, Sheryl Kelsey, Manuel Lombardero, Rocco Mercurio, Gerard Portela, Jennifer Stevenson, Donna Stoliker, Ella Zadorozny, Jane F. Eckstein, Simone Glynn, Eric Leifer, Erin Smith, George Sopko, Phil Tonkins, Pablo Cure, Catherine Levy, Naomi Luban, Barbara Konkle, Deepak Bhatt, Eldad Hod, Cassandra Josephson, KyungMann Kim, Agnes Lee, Leslie Serchuck, Peter Stone, Darby Thompson, Kathryn Weise
Journal: JAMA Network Open (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;amp;lt;7-8 g/dL) or liberal (Hb &amp;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