Carson Jeffrey L, Fergusson Dean A, Noveck Helaine, Mallick Ranjeeta, Simon Tabassome, Rao Sunil V, Cooper Howard, Stanworth Simon J, Portela Gerard T, Ducrocq Gregory, Bertolet Marnie, DeFilippis Andrew P, Goldsweig Andrew M, Kim Sarang, Triulzi Darrell J, Menegus Mark A, Abbott J Dawn, Lopes Renato D, Brooks Maria Mori, Alexander John H, Hébert Paul C, Goodman Shaun G, Steg P Gabriel
Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa.
NEJM Evid. 2025 Feb;4(2):EVIDoa2400223. doi: 10.1056/EVIDoa2400223. Epub 2024 Dec 23.
Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies.
We conducted searches in major databases. Eligible trials randomly assigned patients with MI and anemia to either a restrictive (i.e., transfusion threshold of 7-8 g/dl) or liberal (i.e., transfusion threshold of 10 g/dl) red cell transfusion strategy. We used individual patient data from each trial. The primary outcome was a composite of 30-day mortality or MI.
We included 4311 patients from four trials. The primary outcome occurred in 334 patients (15.4%) in the restrictive strategy and 296 patients (13.8%) in the liberal strategy (relative risk [RR] 1.13, 95% confidence interval [CI], 0.97 to 1.30). Death at 30 days occurred in 9.3% of patients in the restrictive strategy and in 8.1% of patients in the liberal strategy (RR 1.15, 95% CI, 0.95 to 1.39). Cardiac death at 30 days occurred in 5.5% of patients in the restrictive strategy and in 3.7% of patients in the liberal strategy (RR 1.47, 95% CI, 1.11 to 1.94). Heart failure (RR 0.89, 95% CI, 0.70 to 1.13) was similar in the transfusion strategies. All-cause mortality at 6 months occurred in 20.5% of patients in the restrictive strategy compared with 19.1% of patients in the liberal strategy (hazard ratio 1.08, 95% CI, 1.05 to 1.11).
Pooling individual patient data from four trials did not find a definitive difference in our primary composite outcome of MI or death at 30 days. At 6 months, a restrictive transfusion strategy was associated with increased all-cause mortality. (Partially funded by a grant from the U.S. National Heart, Lung, and Blood Institute [R01HL171977].).
临床指南得出结论，目前尚无足够数据可为急性心肌梗死（MI）合并贫血患者红细胞输注的血红蛋白阈值提供推荐。在近期发表心肌梗死与输血（MINT）试验后，我们进行了一项个体患者水平的数据荟萃分析，以评估限制性与宽松输血策略的效果。
我们在主要数据库中进行检索。符合条件的试验将MI合并贫血患者随机分配至限制性（即输血阈值为7 - 8 g/dl）或宽松（即输血阈值为10 g/dl）红细胞输血策略组。我们使用了每个试验的个体患者数据。主要结局是30天死亡率或MI的复合指标。
我们纳入了来自四项试验的4311例患者。限制性策略组有334例患者（15.4%）发生主要结局，宽松策略组有296例患者（13.8%）发生主要结局（相对风险[RR] 1.13，95%置信区间[CI]，0.97至1.30）。限制性策略组30天死亡率为9.3%，宽松策略组为8.1%（RR 1.15，95% CI，0.95至1.39）。限制性策略组30天心脏性死亡发生率为5.5%，宽松策略组为3.7%（RR 1.47，95% CI，1.11至1.94）。心力衰竭（RR 0.89，95% CI，0.70至1.13）在两种输血策略中相似。限制性策略组6个月全因死亡率为20.5%，宽松策略组为19.1%（风险比1.08，95% CI，1.05至1.11）。
汇总四项试验的个体患者数据后，我们发现30天MI或死亡的主要复合结局并无明确差异。在6个月时，限制性输血策略与全因死亡率增加相关。（部分由美国国立心肺血液研究所资助[R01HL171977]）
