Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Aug 1;185(8):947-954.
doi: 10.1001/jamainternmed.2025.0654.

Transfusion Strategy Effect on Quality of Life in Patients With Myocardial Infarction and Anemia: A Secondary Analysis of the MINT Randomized Clinical Trial

Micah T Prochaska  1 , Gerard T Portela  2 , Maria Mori Brooks  2 , Dean A Fergusson  3 , Paul C Hébert  4 , Tamar S Polonsky  1 , Adriano Caixeta  5 , Howard A Cooper  6 , Ian Crozier  7 , Benoit Daneault  8 , Sarang Kim  9 , Kevin R Bainey  10 , Pedro de Barros E Silva  11 , Michael Goldfarb  12 , Rajesh Gupta  13 , Sunil V Rao  14 , Luiz Eduardo Fonteles Ritt  15 , Tabassome Simon  16 , Jeffrey L Carson  9
Affiliations
Randomized Controlled Trial

Transfusion Strategy Effect on Quality of Life in Patients With Myocardial Infarction and Anemia: A Secondary Analysis of the MINT Randomized Clinical Trial

Micah T Prochaska et al. JAMA Intern Med. .

Erratum in

  • Error in Visual Abstract.
    [No authors listed] [No authors listed] JAMA Intern Med. 2025 Sep 15:e254932. doi: 10.1001/jamainternmed.2025.4932. Online ahead of print. JAMA Intern Med. 2025. PMID: 40952728 Free PMC article. No abstract available.

Abstract

Importance: Both myocardial infarction (MI) and anemia have deleterious effects on health-related quality of life (QOL). Red blood cell (RBC) transfusion may improve QOL after MI by relieving symptoms and/or increasing functional capacity.

Objective: To evaluate whether a liberal transfusion strategy compared with a more restrictive transfusion strategy affects QOL in patients with MI and anemia.

Design, setting, and participants: This analysis of QOL as a prespecified secondary outcome of the Myocardial Ischemia and Transfusion (MINT) trial, a randomized clinical trial comparing a liberal vs restrictive RBC transfusion strategy, included participants from 144 sites across 6 countries. Hospitalized adults with acute MI and anemia (hemoglobin [Hb] less than 10 g/dL). The MINT trial randomized 3504 patients, and this analysis included those who had QOL data collected and those who died before the 30-day follow-up period. Data were collected from April 2017 to April 2023, and data were analyzed from February 2024 to January 2025.

Interventions: The MINT trial randomized patients to a restrictive (Hb of 7 to 8 g/dL) or a liberal (Hb of less than 10 g/dL) RBC transfusion strategy.

Main outcomes and measures: QOL was measured using the EQ-5D-5L 30 days after randomization.

Results: Of 2844 included patients, 1551 (54.5%) were male, and the mean (SD) age was 71.9 (11.5) years. A total of 2525 (88.8%; 1254 [49.7%] in the restrictive group and 1271 [50.3%] in the liberal group) had QOL data, and 319 (11.2%) died before 30-day follow-up. Overall, there were no differences in mean or median scores for any EQ-5D-5L QOL outcome between assigned transfusion strategies at 30 days postrandomization. Although a higher percentage of patients in the liberal compared with the restrictive transfusion group reported no problems compared with any problem in usual activities (506 of 1268 [39.9%] vs 473 of 1247 [37.9%]), mobility (474 of 1270 [37.3%] vs 460 of 1254 [36.7%]), and self-care (858 of 1271 [67.5%] vs 803 of 1254 [64.0%]) domains, none of these differences were statistically significant. Adjusted mixed-effects linear regressions showed no association between assigned transfusion strategy and mean differences in any QOL outcome. Adjusted regressions in several prespecified subgroups showed an association between a liberal transfusion strategy and better QOL scores in domains related to functional capacity, but the effects were only statistically significant in patients with a history of heart failure (Health Today rating: β, 2.06 [95% CI, -0.23 to 4.35] vs -1.44 [95% CI, -3.81 to 0.92]; P = .04).

Conclusions and relevance: This secondary analysis of the MINT trial found that in patients with MI and anemia, a liberal transfusion strategy compared with a restrictive transfusion strategy did not affect QOL outcomes 30 days after randomization. This suggests that higher Hb levels maintained with RBC transfusion may not offer significant benefits to QOL overall in patients with MI and anemia. Additional studies may be useful for further examining and validating transfusion's effect on QOL in patients with MI and heart failure.

Trial registration: ClinicalTrials.gov Identifier: NCT02981407.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Prochaska reported grants from the National Institutes of Health during the conduct of the study. Dr Brooks reported grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr Crozier reported grants from Green Lane during the conduct of the study. Dr Barres reported grants from Roche Diagnostics, Novartis, and Bayer outside the submitted work. Dr Fonteles Ritt reported research fees from Novartis, AstraZeneca, and Lilly outside the submitted work. Dr Simon reported grants from the National Heart, Lung, and Blood Institute, the French National Research Agency, the Canadian Blood Services, and the Canadian Institutes of Health Research during the conduct of the study; grants from Novartis, Sanofi, Merck, AstraZeneca, Lilly, Daiichi-Sankyo, GlaxoSmithKline, and the French Ministry of Health; and personal fees from Ablative Solutions, Air Liquide, AstraZeneca, Sanofi, Servier Novartis, and 4Living Biotech outside the submitted work. Dr Carson reported grants from the National Heart, Lung, and Blood Institute during the conduct of the study; personal fees from Cerus and Bristol Myers Squibb outside the submitted work. No other disclosures were reported.

References

    1. Lewis EF, Li Y, Pfeffer MA, et al. Impact of cardiovascular events on change in quality of life and utilities in patients after myocardial infarction: a VALIANT study (valsartan in acute myocardial infarction). JACC Heart Fail. 2014;2(2):159-165. doi: 10.1016/j.jchf.2013.12.003 - DOI - PubMed
    1. Lui JNM, Williams C, Keng MJ, et al. ; REVEAL Collaborative Group . Impact of new cardiovascular events on quality of life and hospital costs in people with cardiovascular disease in the United Kingdom and United States. J Am Heart Assoc. 2023;12(19):e030766. doi: 10.1161/JAHA.123.030766 - DOI - PMC - PubMed
    1. Doll JA. Quality of life after myocardial infarction: more PROgress needed. Heart. 2020;106(1):8-9. doi: 10.1136/heartjnl-2019-315871 - DOI - PubMed
    1. Munyombwe T, Hall M, Dondo TB, et al. Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study. Heart. 2020;106(1):33-39. doi: 10.1136/heartjnl-2019-315510 - DOI - PubMed
    1. Mollon L, Bhattacharjee S. Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis. Health Qual Life Outcomes. 2017;15(1):235. doi: 10.1186/s12955-017-0809-3 - DOI - PMC - PubMed

Publication types

Associated data