Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction

Importance: The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure. Objectives: To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds. Design, Setting, and Participants: The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026. Intervention: The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy. Main Outcomes and Measures: Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority. Results: The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%. Conclusions and Relevance: This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable. Trial Registration: ClinicalTrials.gov Identifier: NCT02981407.

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Journal
JAMA Network Open
Published
2026-07-27
DOI
https://doi.org/10.1001/jamanetworkopen.2026.24991
Primary Topic
Blood transfusion and management
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article
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article

Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction

Rajiv Jauhar, Risheek Kaul, Adam Gershon, LaMonica Daniel et al.
JAMA Network Open
Blood transfusion and management
article

Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction

Rajiv Jauhar, Risheek Kaul, Adam Gershon, LaMonica Daniel, François Martin Carrier, William J. Kostis, M Bertolet, Judah Rauch, Helaine Noveck, Alana Gulliver, Shahab Ghafghazi, Ahmed Hassanin, A. Garvey Rene, Fnu Namrata, Harsha Adnani, Roman Royzman, Estefanía Hernández, Senaratne Jw, Sharon Vincent, Carson Jl, Mohammed Hasan Khan, Umar Rashid, Puneet Gandotra, Hardeep Dholiya, Brandon M. Herbert, Jayakumar Sreenivasan, Barry Kaplan, Frances Wood, R.L. Roswell, Patrick Desanto, Meechai Tessalee, Karen Dragert, Anuritha Tirumani, Sarang Kim, Brandon Dilluvio, Ervin Mazniku, Ian Dalangin, Samanta Baboolall, Emily Strober, Meriton Ruhani, Rachel Gentles, Luis Gruberg, Dinesh Kalra, Sean Taylor, Veronica Day, O Ramírez, Mallory Hatfield, Maria Masih, Amanda Tice, Mollie Machado, Noelle Manning, Angeline Camilo, Rhonda Norton, Kyle Agostini, Sheila Redding, Bernard Kadosh, C B Fordyce, Kristie Coleman, Barry Uretsky, Syed Haidry, Adriano Caixeta, Glynn, Simone, 1960-, Pedro Beraldo de Andrade, Andrew P. DeFilippis, Frederico Toledo Campo Dall'Orto, Brian J. Potter, Ami Patel, Kristin Miller, Loukas Boutis, Carl Reimers, Jasjit Bhinder, Johanne Silvain, Perwaiz Meraj, Muhammad Iqbal, Mark Menegus, Maria Mori Brooks, Jesse Byrd, Jae S. Lee, Yogita Rochlani, Srikanth Vallurupalli, Parija Sharedalal, Gregory Maniatis, Sunil V. Rao, J. Dawn Abbott, Samia Tamazi, Jennifer Moore, Myocardial Ischemia and Transfusion (MINT) Trial Investigators, Anna Koulova, Howard A. Cooper, Barbara Shannon, Craig Basman, Riona Timmons, Richard Dima, Tabassome Simon, Deborah McCloskey, Sheila Davila, Behram Mody, Fei Chen
article en

Abstract

Importance: The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure. Objectives: To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds. Design, Setting, and Participants: The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026. Intervention: The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy. Main Outcomes and Measures: Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority. Results: The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%. Conclusions and Relevance: This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable. Trial Registration: ClinicalTrials.gov Identifier: NCT02981407.

JAMA Network OpenVol. 9(7)
Westchester Medical Center (US), University of British Columbia (CA), University of Alberta (CA), Inserm (FR), University of Pittsburgh (US), Vanderbilt University (US), Brown University (US), Johnson University (US), Vancouver General Hospital (CA), Sorbonne Université (FR), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Saint-Antoine (FR), Myocardial Solutions (United States) (US), National Heart, Lung, and Blood Institute (US), Institut de Biologie Paris-Seine (FR), Pitié-Salpêtrière Hospital (FR), Hospital das Clínicas da Universidade Federal de Minas Gerais (BR), Centre de Recherche Saint-Antoine (FR), Centre Hospitalier de l’Université de Montréal (CA), Adventist Hinsdale Hospital (US), Lifespan (US), Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR), Alliance nationale pour les sciences de la vie et de la santé (FR), Université Paris 1 Panthéon-Sorbonne (FR), New York University (US), Université de Montréal (CA), Universidade Federal de São Paulo (BR)
Good health and well-being
Openalex Percentile: Top 12%
Blood transfusion and management
DOIOpen Access PDFOpenAlex
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