心肌梗死合并慢性肾脏病患者的限制性或自由性输血
Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD.
作者信息
Strom Jordan B, Herbert Brandon M, Bertolet Marnie, Brooks Maria M, Malik Shahbaz A, Lemesle Gilles, Madan Mina, Steg Philippe Gabriel, Hebert Paul C, Traverse Jay H, White Harvey D, Alsweiler Caroline, Gupta Rajesh, Ritt Luiz Eduardo F, Menegus Mark A, Alexander John H, Lopes Renato D, Chaitman Bernard R, Carson Jeffrey L
机构信息
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
出版信息
J Am Soc Nephrol. 2025 Jun 1;36(6):1116-1125. doi: 10.1681/ASN.0000000595. Epub 2025 Jan 9.
KEY POINTS
This Myocardial Ischemia and Transfusion (MINT) trial analysis evaluated the optimal transfusion strategy for patients with CKD and anemia experiencing acute myocardial infarction. In patients with CKD, a liberal transfusion strategy overall did not demonstrate benefit over a restrictive strategy.
BACKGROUND
CKD is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain whether a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff <10 g/dl) is superior to a restrictive transfusion threshold (hemoglobin, 7–8 g/dl) strategy.
METHODS
Among the 3504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with nonmissing serum creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (=1279), CKD with eGFR 30–60 ml/min per 1.73 m (=999), CKD with eGFR <30 ml/min per 1.73 m (=802), and CKD requiring dialysis (=415) by assigned transfusion strategy.
RESULTS
No statistically significant interactions were observed between CKD stage and assigned transfusion strategy. Among non–dialysis-dependent patients with an eGFR <30 ml/min per 1.73 m, a restrictive transfusion strategy was associated with a higher risk of 30-day death or recurrent myocardial infarction (risk difference [RD], 5.8%; 95% confidence interval [CI], 0.4% to 11.2%) compared with a liberal transfusion strategy. Among patients with an eGFR 30–60 ml/min per 1.73 m, a restrictive strategy was associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, 3.7%; 95% CI, −0.9% to 8.2%) compared with a liberal transfusion strategy. Among patients with CKD requiring dialysis, a restrictive strategy was also associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, −2.6%; 95% CI, −10.0% to 4.8%) compared with a liberal transfusion strategy.
CONCLUSIONS
In patients with CKD included in this MINT subgroup analysis, a liberal transfusion strategy was not worse than a restrictive transfusion strategy and was associated with less harm in subgroups not receiving dialysis.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER
: Myocardial Ischemia and Transfusion (MINT), NCT02981407.
关键点
这项心肌缺血与输血（MINT）试验分析评估了患有慢性肾脏病（CKD）和贫血且发生急性心肌梗死患者的最佳输血策略。在CKD患者中，总体而言，宽松输血策略相较于限制性策略并未显示出益处。
背景
CKD与心肌梗死和贫血的较高风险相关。在发生心肌梗死的贫血和CKD患者中，宽松的红细胞输血阈值策略（血红蛋白临界值<10 g/dl）是否优于限制性输血阈值（血红蛋白7 - 8 g/dl）策略仍不确定。
方法
在参与心肌缺血与输血（MINT）试验且血清肌酐数据无缺失的3504例患者中，我们根据指定的输血策略比较了无CKD（n = 1279）、估算肾小球滤过率（eGFR）为30 - 60 ml/（min·1.73 m²）的CKD患者（n = 999）、eGFR<30 ml/（min·1.73 m²）的CKD患者（n = 802）以及需要透析的CKD患者（n = 415）的基线特征、30天和6个月的结局。
结果
未观察到CKD分期与指定输血策略之间存在统计学显著的相互作用。在eGFR<30 ml/（min·1.73 m²）的非透析依赖患者中，与宽松输血策略相比，限制性输血策略与30天死亡或复发性心肌梗死的较高风险相关（风险差异[RD]，5.8%；95%置信区间[CI]，0.4%至11.2%）。在eGFR为30 - 60 ml/（min·1.73 m²）的患者中，与宽松输血策略相比，限制性策略与30天死亡或复发性心肌梗死的风险相似（RD，3.7%；95% CI， - 0.9%至8.2%）。在需要透析的CKD患者中，与宽松输血策略相比，限制性策略与30天死亡或复发性心肌梗死的风险也相似（RD， - 2.6%；95% CI， - 10.0%至4.8%）。
结论
在这项MINT亚组分析纳入的CKD患者中，宽松输血策略并不比限制性输血策略差，并且在未接受透析的亚组中危害较小且有利。
临床试验注册名称及注册号
心肌缺血与输血（MINT），NCT02981407。
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