DeFilippis Andrew P, Abbott J Dawn, Herbert Brandon M, Bertolet Marnie H, Chaitman Bernard R, White Harvey D, Goldsweig Andrew M, Polonsky Tamar S, Gupta Rajesh, Alsweiler Caroline, Silvain Johanne, de Barros E Silva Pedro G M, Hillis Graham S, Daneault Benoit, Tessalee Meechai, Menegus Mark A, Rao Sunil V, Lopes Renato D, Hébert Paul C, Alexander John H, Brooks Maria M, Carson Jeffrey L, Goodman Shaun G
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (A.P.D.).
Lifespan Cardiovascular Institute and Department of Medicine, Division of Cardiology, Alpert Medical School of Warren Alpert Medical School. Brown University, Providence, RI (J.D.A.).
Circulation. 2024 Dec 3;150(23):1826-1836. doi: 10.1161/CIRCULATIONAHA.124.071208. Epub 2024 Aug 29.
The MINT trial (Myocardial Ischemia and Transfusion) raised concern for harm from a restrictive versus liberal transfusion strategy in patients with acute myocardial infarction (MI) and anemia. Type 1 and type 2 MI are distinct pathophysiologic entities that may respond differently to blood transfusion. This analysis sought to determine whether the effects of transfusion varied among patients with a type 1 or a type 2 MI and anemia. The authors hypothesized that the liberal transfusion strategy would be of greater benefit in type 2 than in type 1 MI.
The authors compared rates of death or MI at 30 days in patients with type 1 (n=1460) and type 2 (n=1955) MI and anemia who were randomly allocated to a restrictive (threshold, 7-8 g/dL) or a liberal (threshold, 10 g/dL) transfusion strategy.
The primary outcome of death or MI was observed in 16% of type 1 MI and 15.4% of type 2 MI patients. The rate of death or MI was higher in patients with type 1 MI randomized to a restrictive (18.2%) versus liberal (13.8%) transfusion strategy (relative risk [RR], 1.32 [95% CI, 1.04-1.67]) with no difference observed between the restrictive (15.8%) and liberal (15.1%) transfusion strategies in patients with type 2 MI (RR, 1.05 [95% CI, 0.85-1.29]). The test for a differential effect of transfusion strategy by MI type was not statistically significant ( = 0.16).
The concern for harm with a restrictive transfusion strategy in patients with acute MI and anemia raised in the MINT primary outcome manuscript may be more apparent in patients with type 1 than type 2 MI.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407.
MINT试验（心肌缺血与输血）引发了人们对急性心肌梗死（MI）合并贫血患者采用限制性输血策略与宽松输血策略是否有害的担忧。1型和2型心肌梗死是不同的病理生理实体，对输血的反应可能不同。本分析旨在确定输血效果在1型或2型心肌梗死合并贫血患者中是否存在差异。作者假设，与1型心肌梗死相比，宽松输血策略对2型心肌梗死患者的益处更大。
作者比较了1型心肌梗死（n = 1460）和2型心肌梗死（n = 1955）合并贫血且被随机分配至限制性（阈值，7 - 8 g/dL）或宽松（阈值，10 g/dL）输血策略的患者在30天时的死亡或心肌梗死发生率。
1型心肌梗死患者中有16%以及2型心肌梗死患者中有15.4%观察到主要结局死亡或心肌梗死。随机接受限制性（18.2%）而非宽松（13.8%）输血策略的1型心肌梗死患者的死亡或心肌梗死发生率更高（相对风险[RR]，1.32[95%置信区间，1.04 - 1.67]），而在2型心肌梗死患者中，限制性（15.8%）和宽松（15.1%）输血策略之间未观察到差异（RR，1.05[95%置信区间，0.85 - 1.29]）。按心肌梗死类型对输血策略的差异效应进行的检验无统计学意义（P = 0.16）。
MINT主要结局手稿中提出的急性心肌梗死合并贫血患者采用限制性输血策略有害的担忧，在1型心肌梗死患者中可能比在2型心肌梗死患者中更明显。
