Sunil V Rao, Maria Mori Brooks, Helen E A D'Agostino, P Gabriel Steg, Tabassome Simon, Herbert D Aronow, Andrew M Goldsweig, Shahbaz Malik, Caroline Alsweiler, Kalon K L Ho, Payam Dehghani, Adriano Caixeta, Ata R Quraishi, Simon Robinson, Jay H Traverse, Omar Siddiqi, Dean A Fergusson, Brian J Potter, Joshua Schulman-Marcus, Friederike K Keating, Jeffrey L Carson
{"title":"红细胞输注策略对接受血运重建术的急性心肌梗死患者临床结局的影响：MINT试验的预先分析","authors":"Sunil V Rao, Maria Mori Brooks, Helen E A D'Agostino, P Gabriel Steg, Tabassome Simon, Herbert D Aronow, Andrew M Goldsweig, Shahbaz Malik, Caroline Alsweiler, Kalon K L Ho, Payam Dehghani, Adriano Caixeta, Ata R Quraishi, Simon Robinson, Jay H Traverse, Omar Siddiqi, Dean A Fergusson, Brian J Potter, Joshua Schulman-Marcus, Friederike K Keating, Jeffrey L Carson","doi":"10.1161/CIRCINTERVENTIONS.125.015249","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The MINT trial (Myocardial Ischemia and Transfusion; N=3504) randomized patients with acute myocardial infarction (MI) and hemoglobin ≤10 g/dL to liberal (maintain hemoglobin ≥10 g/dL) or restrictive (maintain hemoglobin ≥8 g/dL) red blood cell transfusion. The results suggested a benefit on 30-day death or MI with a liberal transfusion strategy. The effect of transfusion in patients with acute MI undergoing revascularization is unclear.</p><p><strong>Methods: </strong>In this prespecified analysis of the MINT trial, patients who underwent revascularization (n=1002) before randomization but during index hospitalization were compared with those who did not (n=2442). The primary outcome was 30-day death or MI; secondary outcomes included 30-day death, recurrent MI, the composite of death, recurrent MI, ischemia-driven unscheduled revascularization, or readmission for ischemic cardiac diagnosis, heart failure, and cardiac death. Multivariable log-binomial regression was used to determine the relative risks of the primary and secondary outcomes by transfusion strategy for revascularized and nonrevascularized patients with interaction terms.</p><p><strong>Results: </strong>Patients undergoing revascularization were younger, more often female, and had fewer comorbidities than those who did not. There was no significant interaction between revascularization and assigned transfusion strategy for any outcome except cardiac death. Compared with liberal transfusion, restrictive transfusion increased the risk of 30-day cardiac death among nonrevascularized patients (relative risk, 2.45 [1.58-3.81]) but not among revascularized patients (relative risk, 0.97 [0.59,-1.60]; interaction <i>P</i>=0.006).</p><p><strong>Conclusions: </strong>In this analysis of the MINT trial, revascularization did not alter the effect of the randomized transfusion strategy on 30-day death or MI. The hypothesis-generating finding that a restrictive transfusion strategy was associated with an increased risk of cardiac death among patients with anemia and acute MI who do not undergo revascularization requires confirmation.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015249"},"PeriodicalIF":6.1000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092174/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of Red Blood Cell Transfusion Strategy on Clinical Outcomes Among Patients With Acute Myocardial Infarction Undergoing Revascularization: A Prespecified Analysis of the MINT Trial.\",\"authors\":\"Sunil V Rao, Maria Mori Brooks, Helen E A D'Agostino, P Gabriel Steg, Tabassome Simon, Herbert D Aronow, Andrew M Goldsweig, Shahbaz Malik, Caroline Alsweiler, Kalon K L Ho, Payam Dehghani, Adriano Caixeta, Ata R Quraishi, Simon Robinson, Jay H Traverse, Omar Siddiqi, Dean A Fergusson, Brian J Potter, Joshua Schulman-Marcus, Friederike K Keating, Jeffrey L Carson\",\"doi\":\"10.1161/CIRCINTERVENTIONS.125.015249\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The MINT trial (Myocardial Ischemia and Transfusion; N=3504) randomized patients with acute myocardial infarction (MI) and hemoglobin ≤10 g/dL to liberal (maintain hemoglobin ≥10 g/dL) or restrictive (maintain hemoglobin ≥8 g/dL) red blood cell transfusion. The results suggested a benefit on 30-day death or MI with a liberal transfusion strategy. The effect of transfusion in patients with acute MI undergoing revascularization is unclear.</p><p><strong>Methods: </strong>In this prespecified analysis of the MINT trial, patients who underwent revascularization (n=1002) before randomization but during index hospitalization were compared with those who did not (n=2442). The primary outcome was 30-day death or MI; secondary outcomes included 30-day death, recurrent MI, the composite of death, recurrent MI, ischemia-driven unscheduled revascularization, or readmission for ischemic cardiac diagnosis, heart failure, and cardiac death. Multivariable log-binomial regression was used to determine the relative risks of the primary and secondary outcomes by transfusion strategy for revascularized and nonrevascularized patients with interaction terms.</p><p><strong>Results: </strong>Patients undergoing revascularization were younger, more often female, and had fewer comorbidities than those who did not. There was no significant interaction between revascularization and assigned transfusion strategy for any outcome except cardiac death. Compared with liberal transfusion, restrictive transfusion increased the risk of 30-day cardiac death among nonrevascularized patients (relative risk, 2.45 [1.58-3.81]) but not among revascularized patients (relative risk, 0.97 [0.59,-1.60]; interaction <i>P</i>=0.006).</p><p><strong>Conclusions: </strong>In this analysis of the MINT trial, revascularization did not alter the effect of the randomized transfusion strategy on 30-day death or MI. The hypothesis-generating finding that a restrictive transfusion strategy was associated with an increased risk of cardiac death among patients with anemia and acute MI who do not undergo revascularization requires confirmation.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e015249\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092174/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015249\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015249","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Effect of Red Blood Cell Transfusion Strategy on Clinical Outcomes Among Patients With Acute Myocardial Infarction Undergoing Revascularization: A Prespecified Analysis of the MINT Trial.
Background: The MINT trial (Myocardial Ischemia and Transfusion; N=3504) randomized patients with acute myocardial infarction (MI) and hemoglobin ≤10 g/dL to liberal (maintain hemoglobin ≥10 g/dL) or restrictive (maintain hemoglobin ≥8 g/dL) red blood cell transfusion. The results suggested a benefit on 30-day death or MI with a liberal transfusion strategy. The effect of transfusion in patients with acute MI undergoing revascularization is unclear.
Methods: In this prespecified analysis of the MINT trial, patients who underwent revascularization (n=1002) before randomization but during index hospitalization were compared with those who did not (n=2442). The primary outcome was 30-day death or MI; secondary outcomes included 30-day death, recurrent MI, the composite of death, recurrent MI, ischemia-driven unscheduled revascularization, or readmission for ischemic cardiac diagnosis, heart failure, and cardiac death. Multivariable log-binomial regression was used to determine the relative risks of the primary and secondary outcomes by transfusion strategy for revascularized and nonrevascularized patients with interaction terms.
Results: Patients undergoing revascularization were younger, more often female, and had fewer comorbidities than those who did not. There was no significant interaction between revascularization and assigned transfusion strategy for any outcome except cardiac death. Compared with liberal transfusion, restrictive transfusion increased the risk of 30-day cardiac death among nonrevascularized patients (relative risk, 2.45 [1.58-3.81]) but not among revascularized patients (relative risk, 0.97 [0.59,-1.60]; interaction P=0.006).
Conclusions: In this analysis of the MINT trial, revascularization did not alter the effect of the randomized transfusion strategy on 30-day death or MI. The hypothesis-generating finding that a restrictive transfusion strategy was associated with an increased risk of cardiac death among patients with anemia and acute MI who do not undergo revascularization requires confirmation.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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