TY - JOUR
T1 - Effect of Four Hemoglobin Transfusion Threshold Strategies in Patients With Acute Myocardial Infarction and Anemia
T2 - A Target Trial Emulation Using MINT Trial Data
AU - Portela, Gerard T.
AU - Carson, Jeffrey L.
AU - Swanson, Sonja A.
AU - Alexander, John H.
AU - Hébert, Paul C.
AU - Goodman, Shaun G.
AU - Steg, Philippe Gabriel
AU - Bertolet, Marnie
AU - Strom, Jordan B.
AU - Fergusson, Dean A.
AU - Simon, Tabassome
AU - White, Harvey
AU - Cooper, Howard A.
AU - Abbott, J. Dawn
AU - Rao, Sunil V.
AU - Chaitman, Bernard R.
AU - Fordyce, Christopher B.
AU - Lopes, Renato D.
AU - Daneault, Benoit
AU - Brooks, Maria M.
AU - the MINT Investigators
AU - Alsweiler, Caroline
AU - DeFilippis, Andrew P.
AU - Goldsweig, Andrew M.
AU - Kostis, William J.
AU - Morton, Erin
AU - Noveck, Helaine
AU - Triulzi, Darrell
AU - Kim, Sarang
AU - Dragert, Karen
AU - Patel, Ami
AU - Barbosa, Lilian Mazza
AU - de Barros e Silva, Pedro
AU - Arnaldi Seixas, Liliane A.T.
AU - Arantes, Paola Engelmann
AU - Silva, Larissa Teixeira Aleixo
AU - Damásio, Georgia Beatriz Oliveira
AU - Caron, Julie
AU - Nantel, Micheline
AU - Léon, Pascale
AU - Lebrasseur, Martine
AU - Ducrocq, Gregory
AU - Berard, Laurence
AU - Rousseau, Alexandra
AU - Paco, Sandra
AU - Benhamadi, Narimane
AU - Blesboi, Véléda
AU - Delon, Marie
AU - Ep, Alexia
AU - Mahmoudi, Kaïna
AU - Ledra, Katia
AU - Ramos, Irène Garcia
AU - Henault, Marie
AU - Dantigny, Alexia
AU - Kone, Aichetou
AU - Firoud, Djouher
AU - Arab, Sarah
AU - Pignot, Federica Scialo Véronique
AU - Drouet, Elodie
AU - Nubret, Eunice
AU - Bobin, Margot
AU - Aucan, Christophe
AU - Demerville, Lauren
AU - Bureau, Serge
AU - Preston, Sarah
AU - Simula, Maria
AU - Chew, Derek
AU - Sharma, Yogesh
AU - Aravind, Asha
AU - Hincks, Christine
AU - Hunt, Ivana
AU - Thomas, Simeoni
AU - Wollaston, Fiona
AU - Herbert, Brandon
AU - Kelsey, Sheryl
AU - Lombardero, Manuel
AU - Mercurio, Rocco
AU - Stevenson, Jennifer
AU - Stoliker, Donna
AU - Zadorozny, Ella
AU - Eckstein, Jane F.
AU - de Barros e Silva, Pedro
AU - Glynn, Simone
AU - Leifer, Eric
AU - Smith, Erin
AU - Sopko, George
AU - Tonkins, Phil
AU - Cure, Pablo
AU - Levy, Catherine
AU - Luban, Naomi
AU - Konkle, Barbara
AU - Bhatt, Deepak
AU - Hod, Eldad
AU - Josephson, Cassandra
AU - Kim, Kyung Mann
AU - Lee, Agnes
AU - Serchuck, Leslie
AU - Stone, Peter
AU - Thompson, Darby
AU - Weise, Kathryn
AU - Chen, Fei
AU - Desanto, Patrick
AU - McCloskey, Deborah
AU - Redding, Sheila
AU - Ghafghazi, Shahab
AU - Vincent, Sharon
AU - Dholiya, Hardeep
AU - Kalra, Dinesh
AU - Moore, Jennifer
AU - Hatfield, Mallory
AU - Haidry, Syed
AU - Hassanin, Ahmed
AU - Kaul, Risheek
AU - Namrata, Fnu
AU - Sharedalal, Parija
AU - Sreenivasan, Jayakumar
AU - Bhinder, Jasjit
AU - Khan, Mohammed Hasan
AU - Koulova, Anna
AU - Mody, Behram
AU - Rochlani, Yogita
AU - Tirumani, Anuritha
AU - Wood, Frances
AU - Norton, Rhonda
AU - Daniel, La Monica
AU - Menegus, Mark
AU - Baboolall, Samanta
AU - Davila, Sheila
AU - Manning, Noelle
AU - Machado, Mollie
AU - Rauch, Judah
AU - Camilo, Angeline
AU - Hernandez, Estefania
AU - Iqbal, Muhammad
AU - Mazniku, Ervin
AU - Ramirez, Odilis
AU - Day, Veronica
AU - Uretsky, Barry
AU - Byrd, Jesse
AU - Miller, Kristin
AU - Vallurupalli, Srikanth
AU - Maniatis, Gregory
AU - Dima, Richard
AU - Royzman, Roman
AU - Taylor, Sean
AU - Tice, Amanda
AU - Dilluvio, Brandon
AU - Gruberg, Luis
AU - Gandotra, Puneet
AU - Gentles, Rachel
AU - Shannon, Barbara
AU - Masih, Maria
AU - Roswell, Robert
AU - Gulliver, Alana
AU - Ruhani, Meriton
AU - Strober, Emily
AU - Tamazi, Samia
AU - Gershon, Adam
AU - Coleman, Kristie
AU - Kadosh, Bernard
AU - Jauhar, Rajiv
AU - Adnani, Harsha
AU - Agostini, Kyle
AU - Boutis, Loukas
AU - Dalangin, Ian
AU - Kaplan, Barry
AU - Lee, Jae Sung
AU - Meraj, Perwaiz
AU - Timmons, Riona
AU - Reimers, Carl
AU - Basman, Craig
AU - Rashid, Umar
AU - Rene, Aglae Garvey
AU - Mellor, Asha
AU - duBourg, Karen
AU - Rossi, Joseph
AU - Orgel, Ryan
AU - Reynolds, Emma
AU - Scholl, Tatum
AU - Bogan, Janet
AU - Bogdan, Olivia
AU - Cavender, Matt
AU - Cosentino, Gaetana
AU - De Jesus, Gabriela
AU - Gonzalez, Megan
AU - Hoang, Julia
AU - Kleemann, Emma
AU - Ravenscraft, Deanna
AU - Reed, Teresa
AU - Roark, Joshua
AU - Smith, Samantha
AU - Sternat, Kaitlyn
AU - Tate, Oreyane
AU - Wade, Tyrone
AU - Wolf, Hope
AU - Abtahian, Farhad
AU - Littleton, Megan
AU - Malchoff, Kayla
AU - Mohr, Kelly
AU - Pierce, Emily
AU - LaLonde, Jennifer
AU - Sherron, Kellie
AU - Albro, Tia
AU - Noll, Patty
AU - Tessalee, Meechai
AU - Eaton, Claudia
AU - Barsness, Gregory
AU - Albers, Diana
AU - Jentzer, Jacob
AU - Franchetti, Kelly
AU - Gordon, Catherine
AU - Aronow, Herbert
AU - Cerullo, Ellen
AU - Desimone, Lori Ann
AU - Nowak, Elizabeth
AU - Coccio, Elizabeth
AU - Ramanathan, Kodangudi
AU - Adeboye, Adedayo
AU - Armstrong, Ashley
AU - Johnson, Lillie
AU - Pham, Anh Phuong
AU - Shah, Rahman
AU - Schmidhofer, Mark
AU - Albright, Mary Jo
AU - Enlow, Melissa
AU - Hansra, Barinder
AU - Nicholson, Tracy
AU - Toma, Catalin
AU - Triulzi, Darrell
AU - Basch, Megan
AU - Bernardini, Gretchen
AU - Bollino, Amanda
AU - Dennis, Laurie
AU - Puntil, Kathy
AU - Snyder, Chelsey
AU - Spearman, Linda
AU - Whitehead, Jenny
AU - Keating, Friederike
AU - Harchandani, Bhisham
AU - Sesera, Meghan
AU - Halevy, Jonathan
AU - Raftery, Molly
AU - Roth, Marilynn
AU - Kountz, David
AU - Carson, Michael
PY - 2024/11
Y1 - 2024/11
N2 - Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain. Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia. Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods. (ClinicalTrials.gov: NCT02981407) Setting: 144 clinical sites in 6 countries. Participants: 3492 MINT trial participants with acute MI and a hemoglobin level below 10 g/dL. Intervention: Four transfusion strategies to maintain patients’ hemoglobin concentrations at or above thresholds of 10, 9, 8, or 7 g/dL. Protocol exceptions were permitted for specified adverse clinical events. Measurements: Data from the MINT trial were leveraged to emulate 4 transfusion strategies and estimate per protocol effects on the composite outcome of 30-day death or recurrent MI (death/MI) and 30-day death using inverse probability weighting. Results: The 30-day risk for death/MI was 14.8% (95% CI, 11.8% to 18.4%) for a <10-g/dL strategy, 15.1% (CI, 11.7% to 18.2%) for a <9-g/dL strategy, 15.9% (CI, 12.4% to 19.0%) for a <8-g/dL strategy, and 18.3% (CI, 14.6% to 22.0%) for a <7-g/dL strategy. Absolute risk differences and risk ratios relative to the <10-g/dL strategy for 30-day death/MI increased as thresholds decreased, although 95% CIs were wide. Findings were similar and imprecise for 30-day death. Limitation: Unmeasured confounding may have persisted despite adjustment. Conclusion: The 30-day risks for death/MI and death among patients with acute MI and anemia seem to increase progressively with lower hemoglobin concentration thresholds for transfusion. However, the imprecision around estimates from this target trial analysis precludes definitive conclusions about individual hemoglobin thresholds. Primary Funding Source: National Heart, Lung, and Blood Institute.
AB - Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain. Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia. Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods. (ClinicalTrials.gov: NCT02981407) Setting: 144 clinical sites in 6 countries. Participants: 3492 MINT trial participants with acute MI and a hemoglobin level below 10 g/dL. Intervention: Four transfusion strategies to maintain patients’ hemoglobin concentrations at or above thresholds of 10, 9, 8, or 7 g/dL. Protocol exceptions were permitted for specified adverse clinical events. Measurements: Data from the MINT trial were leveraged to emulate 4 transfusion strategies and estimate per protocol effects on the composite outcome of 30-day death or recurrent MI (death/MI) and 30-day death using inverse probability weighting. Results: The 30-day risk for death/MI was 14.8% (95% CI, 11.8% to 18.4%) for a <10-g/dL strategy, 15.1% (CI, 11.7% to 18.2%) for a <9-g/dL strategy, 15.9% (CI, 12.4% to 19.0%) for a <8-g/dL strategy, and 18.3% (CI, 14.6% to 22.0%) for a <7-g/dL strategy. Absolute risk differences and risk ratios relative to the <10-g/dL strategy for 30-day death/MI increased as thresholds decreased, although 95% CIs were wide. Findings were similar and imprecise for 30-day death. Limitation: Unmeasured confounding may have persisted despite adjustment. Conclusion: The 30-day risks for death/MI and death among patients with acute MI and anemia seem to increase progressively with lower hemoglobin concentration thresholds for transfusion. However, the imprecision around estimates from this target trial analysis precludes definitive conclusions about individual hemoglobin thresholds. Primary Funding Source: National Heart, Lung, and Blood Institute.
KW - blood transfusion
KW - hemoglobin thresholds
KW - Myocardial Ischemia and Transfusion
UR - http://www.scopus.com/inward/record.url?scp=85210105921&partnerID=8YFLogxK
U2 - 10.7326/M24-0571
DO - 10.7326/M24-0571
M3 - Article
C2 - 39348705
AN - SCOPUS:85210105921
SN - 0003-4819
VL - 177
SP - 1489
EP - 1498
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 11
ER -