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UrduFor anemic patients suffering heart attacks, lower hemoglobin thresholds for transfusion may increase risk of death or recurrent heart attack
Abstract: https://www.acpjournals.org/doi/10.7326/M24-0571
Editorial: https://www.acpjournals.org/doi/10.7326/M24-0895
URL goes live when the embargo lifts
Researchers funded by the National Heart, Lung, and Blood Institute studied data from 3,492 MINT trial participants with acute MI and anemia at 144 clinical sites in 6 countries. Participants were selected if they were 18 years or older, had type 1, 2, 4b, or 4c MI, and had a hemoglobin concentration below 10 g/dL. Researchers used target trial emulation methods to assess 4 transfusion strategies with hemoglobin thresholds of <10 g/dL, <9 g/dL, <8 g/dL, or <7 g/dL to trigger red blood cell (RBC) transfusion. The primary outcome of the study was a composite of all-cause death or recurrent MI, while a secondary outcome was all-cause death. Participants were followed until death, loss to follow-up or withdrawal, or day 30, whichever occurred first. The study design was innovative, with researchers synthesizing data from the MINT trial to conduct this secondary analysis that complemented the results of the former trial. The data suggested that risk for 30-day death or MI was higher for hemoglobin transfusion thresholds of less than 8 g/dL and less than 7 g/dL but did not differ for a threshold of less than 9 g/dL, each relative to a less than 10 g/dL threshold, indicating a possible relationship between low hemoglobin concentration thresholds for transfusion and an elevated 30-day risk for death or MI. The lower the threshold, seemingly the higher the risk. The results from this study inform the optimal transfusion threshold for this patient population and may help to guide clinical practice in patients with acute MI. These findings suggest that transfusion guidelines could consider avoiding hemoglobin triggers of less than 8 g/dL and less than 7 g/dL in patients with acute MI to minimize risk for hazardous outcomes.
Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Maria M. Brooks, PhD, please e-mail [email protected].
