{"id":138277,"date":"2024-04-08T08:48:56","date_gmt":"2024-04-08T12:48:56","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138277"},"modified":"2024-04-08T08:48:56","modified_gmt":"2024-04-08T12:48:56","slug":"mint-subgroup-analysis-among-patients-with-acute-mi-and-anemia-a-restrictive-transfusion-strategy-was-associated-with-higher-rates-of-death-and-mi-at-30-days","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138277","title":{"rendered":"MINT subgroup analysis: Among patients with acute MI and anemia, a restrictive transfusion strategy was associated with higher rates of death and MI at 30 days"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The MINT trial found that among patients with acute MI and anemia, those randomized to a liberal transfusion strategy had lower rates death or MI at 30 days compared to a restrictive strategy; this result approached but did not reach statistical significance.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">This prespecified subgroup analysis found that the restrictive strategy resulted in a higher rate of death or MI in patients with Type 1 but not Type 2 MI, however the p-value for interaction was not significant.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Further research is needed, as this analysis was likely underpowered to detect a clinically significant differential response to transfusion strategy based on MI type.\u00a0<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">The Myocardial Ischemia and Transfusion (MINT) tested a restrictive transfusion strategy (Hgb threshold 7-8g\/dL) versus a liberal transfusion strategy (Hgb threshold 10g\/dL) among patients with acute myocardial infarction (MI) and anemia.<\/span><span style=\"font-weight: 400;\">1<\/span><span style=\"font-weight: 400;\"> The primary outcome of death or MI at 30 days was higher in the restrictive arm, but it did not reach the pre-specific cut off for statistical significance (RR 1.15, 95% CI 0.99-1.34), suggesting a potential benefit to a liberal transfusion strategy. Because the underlying pathophysiology of Type I and Type II MI are different, they might have a differential response to the transfusion strategies tested in MINT.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">On April 7, 2024, the principal results of the \u201cRestrictive Versus Liberal Transfusion in Patients with Type 1 or Type 2 MI: A Prespecified Subgroup Analysis of the MINT Trial\u201d were presented at ACC Scientific Sessions 2024. The purpose of this analysis was to evaluate the effects of a restrictive versus liberal transfusion strategy in MINT patients by MI type.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Overall, 3,415 MINT participants were included in this analysis: 1460 with a Type 1 MI and 1955 with a Type 2 MI. The average age was 72 years. Hemoglobin levels at hospital day 3 were similar in Type 1 and Type 2 patients were similar. Among patients with Type 1 MI, those in the restrictive arm had higher rates of death or MI than those in the liberal arm (RR 1.32 [95% CI 1.04-1.67]). No significant difference in the primary outcome was seen among patients with Type 2 MI (RR 1.05 [0.85-1.29)]). However, the p-value for interaction was 0.16, indicating that there was the differential effect of transfusion strategy based on MI type was not statistically signficant.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">This was a subgroup analysis, hence it was likely underpowered to detect clinically meaningful differential effects. In addition, index MI type was classified by enrolling cite, not a central adjudication process, and the treatment team was not masked to the assigned transfusion strategy.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Andrew P. DeFilippis, MD, MSc, of Vanderbilt University Medical Center concluded: \u201cThese inconclusive results require further study\u2026Although the results of this analysis do not provide statistical certainty, the results inform clinicians in the treatment of patients with acute MI and anemia. A restrictive transfusion strategy may be harmful, particularly in those with Type 1 MI.\u201d\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li><span style=\"font-weight: 400;\">Carson JL, Brooks MM, H\u00e9bert PC, et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. <\/span><i><span style=\"font-weight: 400;\">New England Journal of Medicine<\/span><\/i><span style=\"font-weight: 400;\">. 2023;389(26):2446-2456. doi:doi:10.1056\/NEJMoa2307983<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: The MINT trial found that among patients with acute MI and anemia, those randomized to a liberal transfusion strategy had lower rates death or MI at 30 days compared to a restrictive strategy; this result approached but did not reach statistical significance.\u00a0 This prespecified subgroup analysis found that the restrictive strategy resulted in [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[888,8],"tags":[889,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138277","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-acc-2024","7":"category-news","8":"tag-acc-2024","9":"tag-conference","10":"tag-featured","11":"tag-news","12":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138277","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138277"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138277\/revisions"}],"predecessor-version":[{"id":138278,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138277\/revisions\/138278"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138277"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138277"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138277"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138277"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}