Optimizing Blood Transfusion in Patients with Acute Myocardial Infarction

This editorial interprets the MINT trial, which investigated whether a restrictive transfusion strategy (trigger: Hb 7–8 g/dL) differs in safety and efficacy from a liberal strategy (trigger: Hb < 10 g/dL) in patients with acute myocardial infarction. Despite longstanding support for restrictive transfusion thresholds across various populations, MINT showed a non-significant trend favoring liberal transfusion for reducing death and recurrent MI at 30 days (composite RR 1.15; 95% CI 0.99–1.34; P = 0.07). MI (7.2% vs. 8.5%) and death (8.3% vs. 9.9%) rates were modestly lower in the liberal arm, with most subgroups performing better under liberal strategy. The findings challenge previous assumptions rooted in TRICC and observational data that restrictive transfusion is broadly superior. Given that myocardial ischemia directly worsens with anemia, the editorial supports liberal transfusion in MI settings, emphasizing individualized risk assessment over rigid hemoglobin cutoffs. Table 1 summarizes hemoglobin thresholds recommended by multiple clinical guidelines, many of which exclude MI due to lack of definitive evidence until now.

This editorial interprets the MINT trial, which investigated whether a restrictive transfusion strategy (trigger: Hb 7–8 g/dL) differs in safety and efficacy from a liberal strategy (trigger: Hb < 10 g/dL) in patients with acute myocardial infarction. Despite longstanding support for restrictive transfusion thresholds across various populations, MINT showed a non-significant trend favoring liberal transfusion for reducing death and recurrent MI at 30 days (composite RR 1.15; 95% CI 0.99–1.34; P = 0.07). MI (7.2% vs. 8.5%) and death (8.3% vs. 9.9%) rates were modestly lower in the liberal arm, with most subgroups performing better under liberal strategy. The findings challenge previous assumptions rooted in TRICC and observational data that restrictive transfusion is broadly superior. Given that myocardial ischemia directly worsens with anemia, the editorial supports liberal transfusion in MI settings, emphasizing individualized risk assessment over rigid hemoglobin cutoffs. Table 1 summarizes hemoglobin thresholds recommended by multiple clinical guidelines, many of which exclude MI due to lack of definitive evidence until now.