Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

The MINT trial randomized 3504 patients with acute myocardial infarction (type 1 or type 2) and anemia (Hb <10 g/dL) to a restrictive transfusion strategy (trigger: Hb <7–8 g/dL) or liberal strategy (Hb <10 g/dL). Over 30 days, the primary composite outcome of death or MI occurred in 16.9% vs. 14.5% (RR 1.15; 95% CI: 0.99–1.34; P = 0.07). Death (9.9% vs. 8.3%; RR 1.19) and MI (8.5% vs. 7.2%; RR 1.19) favored the liberal approach, though results were not statistically significant. Total red-cell units transfused: 4325 vs. 1237. Cardiac death (5.5% vs. 3.2%; RR 1.74) was significantly lower with the liberal strategy. Heart failure rates were similar, while transfusion-associated cardiac overload (TACO) was more frequent with liberal transfusion. Subgroup analysis showed greater benefit in type 1 MI and low eGFR. Authors conclude liberal transfusion did not significantly lower death/MI, but restrictive strategy may introduce harm. Findings challenge previous generalizations favoring restrictive transfusion across all patient populations.

The MINT trial randomized 3504 patients with acute myocardial infarction (type 1 or type 2) and anemia (Hb <10 g/dL) to a restrictive transfusion strategy (trigger: Hb <7–8 g/dL) or liberal strategy (Hb <10 g/dL). Over 30 days, the primary composite outcome of death or MI occurred in 16.9% vs. 14.5% (RR 1.15; 95% CI: 0.99–1.34; P = 0.07). Death (9.9% vs. 8.3%; RR 1.19) and MI (8.5% vs. 7.2%; RR 1.19) favored the liberal approach, though results were not statistically significant. Total red-cell units transfused: 4325 vs. 1237. Cardiac death (5.5% vs. 3.2%; RR 1.74) was significantly lower with the liberal strategy. Heart failure rates were similar, while transfusion-associated cardiac overload (TACO) was more frequent with liberal transfusion. Subgroup analysis showed greater benefit in type 1 MI and low eGFR. Authors conclude liberal transfusion did not significantly lower death/MI, but restrictive strategy may introduce harm. Findings challenge previous generalizations favoring restrictive transfusion across all patient populations.