Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD

Key Points This Myocardial Ischemia and Transfusion (MINT) trial analysis evaluated the optimal transfusion strategy for patients with CKD and anemia experiencing acute myocardial infarction. In patients with CKD, a liberal transfusion strategy overall did not demonstrate benefit over a restrictive strategy. Background CKD is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain whether a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff <10 g/dl) is superior to a restrictive transfusion threshold (hemoglobin, 7–8 g/dl) strategy. Methods Among the 3504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with nonmissing serum creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD ( N =1279), CKD with eGFR 30–60 ml/min per 1.73 m 2 ( N =999), CKD with eGFR <30 ml/min per 1.73 m 2 ( N =802), and CKD requiring dialysis ( N =415) by assigned transfusion strategy. Results No statistically significant interactions were observed between CKD stage and assigned transfusion strategy. Among non–dialysis-dependent patients with an eGFR <30 ml/min per 1.73 m 2 , a restrictive transfusion strategy was associated with a higher risk of 30-day death or recurrent myocardial infarction (risk difference [RD], 5.8%; 95% confidence interval [CI], 0.4% to 11.2%) compared with a liberal transfusion strategy. Among patients with an eGFR 30–60 ml/min per 1.73 m 2 , a restrictive strategy was associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, 3.7%; 95% CI, −0.9% to 8.2%) compared with a liberal transfusion strategy. Among patients with CKD requiring dialysis, a restrictive strategy was also associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, −2.6%; 95% CI, −10.0% to 4.8%) compared with a liberal transfusion strategy. Conclusions In patients with CKD included in this MINT subgroup analysis, a liberal transfusion strategy was not worse than a restrictive transfusion strategy and was associated with less harm in subgroups not receiving dialysis. Clinical Trial registry name and registration number: Myocardial Ischemia and Transfusion (MINT), NCT02981407.