Key result
Liberal transfusion strategy links to lower 30-day death or MI rates versus a restrictive strategy.
Why the study?
The study was conducted to estimate the per-protocol effect of restrictive versus liberal transfusion strategies among patients from the MINT trial.
Does a restrictive transfusion strategy reduce 30-day death or recurrent MI in patients from the MINT trial compared to a liberal transfusion strategy?
Does a restrictive transfusion strategy reduce 30-day death or recurrent MI in patients from the MINT trial compared to a liberal transfusion strategy?
Per-protocol analyses of the MINT trial suggest that a restrictive transfusion strategy may be associated with a greater risk of 30-day death or recurrent MI compared to a liberal strategy, though instrumental variable analysis aligns with the original ITT findings.
Answers are grounded in this paper and cite their sources.
Supports liberal transfusion in anemic MI patients; confirms MINT ITT findings with consistent per-protocol results.
• Adherence to the assigned transfusion strategy was higher in the restrictive than the liberal transfusion strategy group. • Patients who adhered to the assigned transfusion strategy tended to be lower risk than patients who did not adhere. • In a range of per-protocol analyses, patients receiving a liberal transfusion strategy had lower rates of death or MI and death than patients receiving a restrictive transfusion strategy. • Instrumental variable analysis results were consistent with the intention-to-treat findings We conducted a series of analyses to estimate the per-protocol effect of restrictive versus liberal transfusion strategies on 30-day death and death or recurrent myocardial infarction (MI) among patients from the Myocardial Ischemia and Transfusion (MINT) trial. Multiple analytic approaches were used to estimate the per-protocol effect, including analyses based on different definitions of adherence (site-reported, time-based, transfusion delay) and an instrumental variable analysis. Analyses based on adherence definitions found a restrictive strategy was associated with a substantially greater risk of 30-day death or recurrent MI, while the instrumental variable analysis estimated a moderate treatment effect similar to the original ITT result.
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Herbert et al. (2026) studied this question. In the MINT trial, a liberal transfusion strategy was associated with lower 30-day death or MI rates compared to a restrictive strategy, consistent across analyses.
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