Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction: A Secondary Analysis of the MINT Trial.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL JAMA Network Open Pub Date : 2024-11-04 DOI:10.1001/jamanetworkopen.2024.42361
François M Carrier, Howard A Cooper, Gerard T Portela, Marnie Bertolet, Gilles Lemesle, Micah Prochaska, Sarang Kim, John H Alexander, Ian Crozier, Gregory Ducrocq, Alexandre S Quadros, Akshay Bagai, Marianna Dracoulakis, Mina Madan, Maria M Brooks, Jeffrey L Carson, Paul C Hébert
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Abstract

Importance: In patients with acute myocardial infarction (MI), limited physiologic adaptation to acute anemia might lead to greater benefit from a liberal red blood cell (RBC) transfusion strategy. Data on such a possible benefit are lacking.

Objectives: To compare acute anemia with chronic anemia and post-MI outcomes and estimate the differential effect of a restrictive RBC transfusion strategy compared with a liberal strategy on post-MI outcomes according to anemia acuity.

Design, setting, and participants: A prespecified subgroup analysis of the Myocardial Ischemia and Transfusion (MINT) multicenter randomized clinical trial was conducted in 126 hospitals in 6 countries between April 26, 2017, and April 14, 2023, with 30-day follow-up and blinded adjudication of the primary outcome. The analysis included 3144 of 3504 MINT participants (89.7%) with acute MI, a hemoglobin (Hb) level less than 10 g/dL at randomization, and a first Hb measurement available on the day of or the day following hospital admission.

Intervention: The MINT trial randomized participants to a restrictive (Hb <7-8 g/dL) or liberal (Hb <10 g/dL) RBC transfusion strategy. Acute anemia was defined as having a first Hb value greater than 13 g/dL (men) or 12 g/dL (women), or as having a decrease greater than or equal to 2 g/dL between the first Hb measurement and measurement at randomization. Other Hb levels were categorized as chronic anemia.

Main outcomes and measures: The primary outcome was a composite of death or recurrent MI up to 30 days after randomization. Secondary outcomes were death, recurrent MI, cardiac death, heart failure, pulmonary complications, and major bleeding events. Intention-to-treat analysis was performed.

Results: Among 3144 included participants (mean [SD] age, 72.3 [11.6] years; 1715 [54.5%] male; 1307 [41.6%] with type 1 MI), 1078 [34.3%]) had acute anemia. Acute anemia was associated with an increased risk of death or recurrent MI (adjusted risk ratio, 1.25; 95% CI, 1.05-1.48). The effect of a restrictive RBC transfusion strategy compared with a liberal strategy was similar for participants with either acute or chronic anemia for all outcomes.

Conclusions and relevance: In this secondary analysis of the MINT trial, acute anemia was associated with less favorable post-MI outcomes than chronic anemia but did not modify the effects of the randomized transfusion strategy. In patients with anemia and MI, the acuity of anemia should not influence the choice of transfusion trigger.

Trial registration: ClinicalTrials.gov Identifier: NCT02981407.

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贫血对急性心肌梗死患者输血策略的影响:MINT 试验的二次分析。
重要性:在急性心肌梗死(MI)患者中,由于对急性贫血的生理适应能力有限,因此可能会从宽松的红细胞(RBC)输注策略中获得更多益处。目前还缺乏有关这种可能益处的数据:比较急性贫血与慢性贫血以及心肌梗死后的预后,并根据贫血的严重程度估算限制性红细胞输注策略与宽松策略对心肌梗死后预后的不同影响:心肌缺血与输血(MINT)多中心随机临床试验的预设亚组分析于 2017 年 4 月 26 日至 2023 年 4 月 14 日期间在 6 个国家的 126 家医院进行,随访 30 天并对主要结果进行盲法判定。分析包括 3504 名 MINT 参与者中的 3144 人(89.7%),他们患有急性心肌梗死,随机化时血红蛋白(Hb)水平低于 10 g/dL,入院当天或次日可进行首次 Hb 测量:MINT试验将参与者随机分配到限制性(Hb 主要结果和测量指标:主要结果为随机化后 30 天内死亡或复发性心肌梗死的综合结果。次要结局为死亡、复发性心肌梗死、心源性死亡、心力衰竭、肺部并发症和大出血事件。进行了意向治疗分析:在3144名参与者(平均[标码]年龄为72.3[11.6]岁;1715[54.5%]名男性;1307[41.6%]名1型心肌梗死患者)中,1078[34.3%]名参与者患有急性贫血。急性贫血与死亡或复发性心肌梗死的风险增加有关(调整后风险比为 1.25;95% CI,1.05-1.48)。对于急性或慢性贫血的参与者,限制性红细胞输注策略与自由策略相比,对所有结果的影响相似:在这项 MINT 试验的二次分析中,急性贫血与心肌梗死后较差的预后有关,而与慢性贫血无关,但不会改变随机输血策略的效果。对于贫血合并心肌梗死的患者,贫血的严重程度不应影响输血诱因的选择:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT02981407。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
期刊最新文献
JAMA Network Open. Meal Timing Interventions for Weight Loss and Metabolic Health-What Does the Evidence Tell Us So Far? Saving Children's Lives Through Universal Pediatric Readiness Is a Wise Investment. Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction: A Secondary Analysis of the MINT Trial. Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.
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