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Randomized Controlled Trial
. 2024 Nov 4;7(11):e2442361.
doi: 10.1001/jamanetworkopen.2024.42361.

Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction: A Secondary Analysis of the MINT Trial

François M Carrier  1   2 , Howard A Cooper  3 , Gerard T Portela  4 , Marnie Bertolet  4 , Gilles Lemesle  5   6   7   8 , Micah Prochaska  9 , Sarang Kim  10 , John H Alexander  11 , Ian Crozier  12 , Gregory Ducrocq  13 , Alexandre S Quadros  14 , Akshay Bagai  15 , Marianna Dracoulakis  16 , Mina Madan  17   18 , Maria M Brooks  19 , Jeffrey L Carson  10 , Paul C Hébert  20   21 ; MINT Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction: A Secondary Analysis of the MINT Trial

François M Carrier et al. JAMA Netw Open. .

Abstract

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 <7-8 g/dL) or liberal (Hb <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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carrier is the holder of a transfusion medicine research chair at the Université de Montréal and reported receiving a clinician research award from the Fonds de Recherche du Québec-Santé and grants from the Canadian Institute of Health Research during the conduct of the study. Dr Bertolet reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Alexander reported receiving research grants through Duke University from Artivion/CryoLife, Bayer, Bristol-Myers Squibb, CSL Behring, Ferring, the US Food and Drug Administration, Humacyte, and the NIH; and receiving honoraria, advisory board, or consulting payments from AbbVie, Artivion/CryoLife, AtriCure, Bayer, Bristol-Myers Squibb, Curis, Eli Lilly, Ferring, GlaxoSmithKline, Janssen, Novostia, Pfizer, Portola, Theravance, and Veralox. Dr Crozier reported receiving grants from the Green Lane Coordinating Centre for a noncommercial study and a minimal research grant from the Green Lane Coordinating Centre for a noncommercial study during the conduct of the study. Prof Ducrocq reported receiving personal fees from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boston Scientific, BMS, Novo Nordisk, and Sanofi outside the submitted work. Dr Bagai reported receiving proctorship fees from Abbott and consulting fees from Teleflex and Novo Nordisk outside the submitted work. Dr Madan reported receiving personal fees from Medtronic Canada and Novo Nordisk outside the submitted work. Dr Brooks reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study and being a paid member of the data safety and monitoring board for Cerus Corporation outside the submitted work. Dr Carson reported receiving grants from the NHLBI during the conduct of the study, fees from Cerus Corporation as chair of the data safety and monitoring board outside the submitted work, and personal fees from Bristol-Myers Squibb for giving a lecture. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Inclusion in Myocardial Ischemia and Transfusion (MINT) Acute Anemia Secondary Analysis
Exclusions for hemoglobin not measured on the day of or day after admission were specific to this secondary analysis of the MINT trial. To convert hemoglobin to grams per liter, multiply by 10.
Figure 2.
Figure 2.. Effect of a Restrictive Strategy Compared With a Liberal Strategy on 30-Day Outcomes
Results are presented for the full sample and in each group of anemia acuity. Risk ratio (RR) values greater than 1 favor a liberal strategy. Pulmonary complications were transfusion-related acute lung injury, transfusion-associated circulatory overload, pneumonia, and acute respiratory failure. Models were adjusted for age, sex, smoking status (never, ever, current, or unknown), anemia-related comorbidities (cancer, chronic kidney disease, or diabetes), baseline hemoglobin (grams per deciliter), myocardial infarction (MI) type (type 1, type 2, or other), number of anticoagulants (warfarin, heparin, or other) and antiplatelets (aspirin, P2Y12 inhibitor, or glycoprotein IIb/IIIa inhibitor) and included a random effect for clinical site.
See this image and copyright information in PMC

References

    1. Kunadian V, Mehran R, Lincoff AM, et al. . Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol. 2014;114(12):1823-1829. doi:10.1016/j.amjcard.2014.09.023 - DOI - PubMed
    1. Anker SD, Voors A, Okonko D, et al. ; OPTIMAAL Investigators . Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial. Eur Heart J. 2009;30(11):1331-1339. doi:10.1093/eurheartj/ehp116 - DOI - PubMed
    1. Tsujita K, Nikolsky E, Lansky AJ, et al. . Impact of anemia on clinical outcomes of patients with ST-segment elevation myocardial infarction in relation to gender and adjunctive antithrombotic therapy (from the HORIZONS-AMI trial). Am J Cardiol. 2010;105(10):1385-1394. doi:10.1016/j.amjcard.2010.01.001 - DOI - PubMed
    1. Sabatine MS, Morrow DA, Giugliano RP, et al. . Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111(16):2042-2049. doi:10.1161/01.CIR.0000162477.70955.5F - DOI - PubMed
    1. Mamas MA, Kwok CS, Kontopantelis E, et al. . Relationship between anemia and mortality outcomes in a national acute coronary syndrome cohort: insights from the UK Myocardial Ischemia National Audit Project Registry. J Am Heart Assoc. 2016;5(11):e003348. doi:10.1161/JAHA.116.003348 - DOI - PMC - PubMed

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