Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia
- Carson, Jeffrey L. M.D.
- Brooks, Maria Mori Ph.D.
- Hébert, Paul C. M.D., M.H.Sc.
- Goodman, Shaun G. M.D.
- Bertolet, Marnie Ph.D.
- Glynn, Simone A. M.D., M.P.H.
- Chaitman, Bernard R. M.D.
- Simon, Tabassome M.D., Ph.D.
- Lopes, Renato D. M.D., Ph.D.
- Goldsweig, Andrew M. M.D.
- DeFilippis, Andrew P. M.D.
- Abbott, Dawn J. M.D.
- Potter, Brian J. M.D.C.M.
- Carrier, Francois Martin M.D.
- Rao, Sunil V. M.D.
- Cooper, Howard A. M.D.
- Ghafghazi, Shahab M.D.
- Fergusson, Dean A. Ph.D.
- Kostis, William J. Ph.D., M.D.
- Noveck, Helaine M.P.H.
- Kim, Sarang M.D.
- Tessalee, Meechai M.D.
- Ducrocq, Gregory M.D., Ph.D.
- Melo de Barros e Silva, Pedro Gabriel M.D.
- Triulzi, Darrell J. M.D.
- Alsweiler, Caroline M.H.Sc.
- Menegus, Mark A. M.D.
- Neary, John D. M.D.
- Uhl, Lynn M.D.
- Strom, Jordan B. M.D.
- Fordyce, Christopher B. M.D., M.H.S.
- Ferrari, Emile M.D.
- Silvain, Johanne M.D., Ph.D.
- Wood, Frances O. M.D.
- Daneault, Benoit M.D.
- Polonsky, Tamar S. M.D.
- Senaratne, Manohara M.D.
- Puymirat, Etienne M.D.
- Bouleti, Claire M.D.
- Lattuca, Benoit M.D.
- White, Harvey D. M.D.
- Kelsey, Sheryl F. Ph.D.
- Steg, Gabriel P. M.D.
- Alexander, John H. M.D., M.H.S.
Abstract
Background
A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.
Methods
In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.
Results
A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).
Conclusions
In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)
Transfusion Strategy in Patients with MI and Anemia
In patients with myocardial infarction and anemia, a liberal transfusion strategy led to fewer deaths and heart attacks than a restricted transfusion strategy, but the difference was of borderline significance.