MINT: Myocardial Ischemia and Transfusion

Multiple randomized controlled trials (RCTs) have demonstrated the safety of transfusion thresholds using a lower hemoglobin concentration (restrictive transfusion strategy) compared to higher hemoglobin threshold (liberal transfusion strategy). A restrictive transfusion strategy is the standard of care in most clinical settings although guidelines recognized the need for trials in myocardial infarction where the evidence was lacking.

With the support the NHLBI, we performed a multicenter pragmatic randomized controlled trial to compare the effectiveness of a liberal or restrictive blood transfusion strategy in patients with acute myocardial infarction and anemia. The Myocardial Ischemia and Transfusion (MINT) trial randomly allocated 3504 patients with acute myocardial infarction and hemoglobin concentration less than 10 g/dL from 144 centers located in the United States, Canada, France, Brazil, New Zealand and Australia to be treated according to a liberal or a restrictive blood transfusion strategy. Patients randomized to the liberal transfusion strategy were to receive blood transfusions to maintain their hemoglobin level at or above 10 g/dL. Patients randomized to the restrictive strategy were permitted to receive a blood transfusion if the blood count was below 8 g/dL and strongly encouraged to transfuse if hemoglobin concentration was less than 7 g/dL or for symptoms of angina. The trial primary outcome was all cause mortality or adjudicated recurrent acute myocardial infarction at 30 days.

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