Comparative Efficacy of Transfusion Strategies in Women and Men With Myocardial Infarction and Anemia: Prespecified Secondary Findings From the MINT Trial

BACKGROUND: The optimal transfusion strategy in patients with acute myocardial infarction (AMI) and anemia may be influenced by sex differences in pathophysiology and cardiovascular outcomes. The Myocardial Ischemia and Transfusion trial (MINT) randomized patients with AMI and anemia to restrictive or liberal transfusion thresholds, but sex-stratified outcomes remain undefined. The objective was to evaluate whether the clinical effect of restrictive versus liberal red blood cell transfusion strategies differs by sex in patients hospitalized with AMI and anemia. METHODS: In this prespecified secondary analysis of the MINT trial, we examined outcomes by sex and transfusion strategy. The primary outcome was 30-day composite death or MI. Secondary outcomes included heart failure, stroke, cardiac death, and 180-day mortality. Adjusted relative risks (RRs) and hazard ratios (HRs) were estimated accounting for sex differences at baseline. Interactions between sex and transfusion effects were assessed. RESULTS: There were 3504 study participants, of whom 1593 (45.4%) were women. Women received fewer transfusions on average. Primary outcome occurred in 15.4% of women and 15.4% of men and occurred in 16.5% of women and 17.1% of men in the restrictive arm, versus 14.9% and 14.2% in the liberal arm, respectively. Women had a lower 180-day mortality (11.0% versus 13.5%; P =0.04). There were no statistically significant interactions between sex and transfusion strategy for the primary outcome (interaction P =0.60). For 30-day cardiac death, a higher RR in men was observed in the restrictive transfusion arm (RR, 2.34; 95% CI, 1.48–3.70; interaction P =0.05). CONCLUSIONS: For MINT patients with anemia and AMI, women comprised nearly half of the study population, and randomization to a restrictive or liberal transfusion strategy resulted in comparable outcomes in women and men. These findings support sex-neutral transfusion thresholds. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02981407.

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Journal
Circulation
Published
2026-05-18
DOI
https://doi.org/10.1161/circulationaha.125.078320
Primary Topic
Blood transfusion and management
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article

Comparative Efficacy of Transfusion Strategies in Women and Men With Myocardial Infarction and Anemia: Prespecified Secondary Findings From the MINT Trial

Andrzej Szczudlik, Sergii Moskovko, Alicia Martínez‐Piñeiro, Raffaele Federico Iorio et al.
Circulation
Blood transfusion and management
article

Comparative Efficacy of Transfusion Strategies in Women and Men With Myocardial Infarction and Anemia: Prespecified Secondary Findings From the MINT Trial

Andrzej Szczudlik, Sergii Moskovko, Alicia Martínez‐Piñeiro, Raffaele Federico Iorio, Hsueh‐Wen Hsueh, И. Е. Повереннова, Anetta Lasek‐Bal, Kelly G. Gwathmey, Evgeny Evdoshenko, Carlo Antozzi, Alice K. Jacobs, Renato Mantegazza, George A. Small, Marnie Bertolet, R. E. Yakubtsevich, Lan Chu, Ting Chang, Halina Navumava, Richard J. Nowak, Daniel Thomas Pereira Lopes, Denis Korobko, Marcelo Vianna Raffo, Eduardo Estephan, Yuan‐Ting Sun, Nai‐Wen Tsai, Sanjay Ramteke, Rahul Baviskar, Yasushi Suzuki, Russian Federation, Surya Prabha Turaga, Jiann‐Horng Yeh, Florencia Aguirre, Colleen M. Ballantyne, Maria M. Brooks, Yessar M. Hussain, Andrew M. Goldsweig, Rukmini Kandadai, Ratna Bhavaraju-Sanka, Dian He, J. Dawn Abbott, Urvi Desai, Jayantee Kalita S, Chongbo Zhao, Praveen Kumar Arvind N. Prabhu, Jing Li, Alexandre Guerreiro, Aziz Shaibani, Sabrina Sacconi, Long-Sun Ro, Tabassome Simon, Dean A. Fergusson, Eduardo Aguera Morales, Inna Smagina, Karolina Piasecka-Stryczynska, Małgorzata Zajda, Aleksandra Nadaj-Pakleza, Jeeyoung Oh, Olga Shulga, Joanna Siuda, Chen-Chih Chung, Neeharika Lakshmi Mathukumalli, Qi Fang, Genya Watanabe, P. Gabriel Steg, Byoung Joon Kim, Jeffrey L. Carson, Brandon M. Hebert, Anirudha Apte, Yury Holets, Masako Suzuki, Yury Trinitatskiy, Conrado Estol, Takayuki Kondo, Yuwei Da, Marcelo Rugiero, Wilson Marques, Kimiaki Utsugisawa, Akiyuki Uzawa, Shaun G. Goodman, Waqar Waheed, Nicholas Streicher, Jocelyne R. Benatar, Xinghu Zhang, Oleksandr Doroshenko, South Korea, Oleksandr Kalbus, Rahul Kulkarni, Yi-Chung Lee, Ha Young Shin, Ihsan Sukru Sengun, Klara Bakhtiyarova, Tuan Vu, Vera Bril, Fudong Shi, Elena Parshina, Zoya Goncharova, Ali A. Habib, Ayse Nur Yuceyar, Harvey D. White, Tim Hagenacker
article en

Abstract

BACKGROUND: The optimal transfusion strategy in patients with acute myocardial infarction (AMI) and anemia may be influenced by sex differences in pathophysiology and cardiovascular outcomes. The Myocardial Ischemia and Transfusion trial (MINT) randomized patients with AMI and anemia to restrictive or liberal transfusion thresholds, but sex-stratified outcomes remain undefined. The objective was to evaluate whether the clinical effect of restrictive versus liberal red blood cell transfusion strategies differs by sex in patients hospitalized with AMI and anemia. METHODS: In this prespecified secondary analysis of the MINT trial, we examined outcomes by sex and transfusion strategy. The primary outcome was 30-day composite death or MI. Secondary outcomes included heart failure, stroke, cardiac death, and 180-day mortality. Adjusted relative risks (RRs) and hazard ratios (HRs) were estimated accounting for sex differences at baseline. Interactions between sex and transfusion effects were assessed. RESULTS: There were 3504 study participants, of whom 1593 (45.4%) were women. Women received fewer transfusions on average. Primary outcome occurred in 15.4% of women and 15.4% of men and occurred in 16.5% of women and 17.1% of men in the restrictive arm, versus 14.9% and 14.2% in the liberal arm, respectively. Women had a lower 180-day mortality (11.0% versus 13.5%; P =0.04). There were no statistically significant interactions between sex and transfusion strategy for the primary outcome (interaction P =0.60). For 30-day cardiac death, a higher RR in men was observed in the restrictive transfusion arm (RR, 2.34; 95% CI, 1.48–3.70; interaction P =0.05). CONCLUSIONS: For MINT patients with anemia and AMI, women comprised nearly half of the study population, and randomization to a restrictive or liberal transfusion strategy resulted in comparable outcomes in women and men. These findings support sex-neutral transfusion thresholds. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02981407.

Circulation
Boston Medical Center (US), Nebraska Medical Center (US), University Health Network (CA), Baystate Medical Center (US), University of Pittsburgh (US), Université Paris Cité (FR), Meta (Israel) (IL), Brown University (US), Ottawa Hospital (CA), Johnson University (US), Sorbonne Université (FR), Sorbonne Paris Cité (FR), Greenlane Clinical Centre (NZ), Assistance Publique – Hôpitaux de Paris (FR), Canadian VIGOUR Centre (CA), Ottawa Hospital Research Institute (CA), University of Nebraska Medical Center (US)
Good health and well-being
Openalex Percentile: Top 8%
Blood transfusion and management
DOISourceOpenAlex
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