Key result
Restrictive transfusion matches liberal strategy for 30-day death or MI in both sexes.
Why the study?
Sex differences in pathophysiology and cardiovascular outcomes may influence optimal transfusion strategies in patients with AMI and anemia, but sex-stratified outcomes from the MINT trial remained undefined.
Does a restrictive red blood cell transfusion strategy reduce 30-day death or recurrent myocardial infarction differently in women compared to men with AMI and anemia?
RCT (n=3,504)
Open-label
Randomized
Yes
Does a restrictive red blood cell transfusion strategy reduce 30-day death or recurrent myocardial infarction differently in women compared to men with AMI and anemia?
This prespecified analysis shows that the relative efficacy and safety of restrictive versus liberal transfusion strategies in acute myocardial infarction with anemia are similar in women and men, supporting sex-neutral transfusion thresholds.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“While the trial did not produce a statistically significant difference between the two transfusion strategies for the primary outcome, the results suggest the possibility of liberal transfusion benefits without undue risk.”
“We think these results suggest that a liberal transfusion strategy may be most prudent for some patients without introducing excess risks of harm.”
“I would still recommend a liberal transfusion strategy. It doesn't harm quality of life, but if your rationale is, 'I'm going in there to improve their quality of life,' then, at least overall, we didn't see an effect.”
Supports sex-neutral transfusion thresholds in anemic MI; confirms absence of sex interaction in prespecified MINT analysis.
BACKGROUND: The optimal transfusion strategy in patients with acute myocardial infarction (AMI) and anemia may be influenced by sex differences in pathophysiology and cardiovascular outcomes. The Myocardial Ischemia and Transfusion trial (MINT) randomized patients with AMI and anemia to restrictive or liberal transfusion thresholds, but sex-stratified outcomes remain undefined. The objective was to evaluate whether the clinical effect of restrictive versus liberal red blood cell transfusion strategies differs by sex in patients hospitalized with AMI and anemia. METHODS: In this prespecified secondary analysis of the MINT trial, we examined outcomes by sex and transfusion strategy. The primary outcome was 30-day composite death or MI. Secondary outcomes included heart failure, stroke, cardiac death, and 180-day mortality. Adjusted relative risks (RRs) and hazard ratios (HRs) were estimated accounting for sex differences at baseline. Interactions between sex and transfusion effects were assessed. RESULTS: There were 3504 study participants, of whom 1593 (45.4%) were women. Women received fewer transfusions on average. Primary outcome occurred in 15.4% of women and 15.4% of men and occurred in 16.5% of women and 17.1% of men in the restrictive arm, versus 14.9% and 14.2% in the liberal arm, respectively. Women had a lower 180-day mortality (11.0% versus 13.5%; P =0.04). There were no statistically significant interactions between sex and transfusion strategy for the primary outcome (interaction P =0.60). For 30-day cardiac death, a higher RR in men was observed in the restrictive transfusion arm (RR, 2.34; 95% CI, 1.48–3.70; interaction P =0.05). CONCLUSIONS: For MINT patients with anemia and AMI, women comprised nearly half of the study population, and randomization to a restrictive or liberal transfusion strategy resulted in comparable outcomes in women and men. These findings support sex-neutral transfusion thresholds. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02981407.
Abbott et al. (2026) conducted an RCT in Acute myocardial infarction and anemia (n=3,504). Restrictive transfusion strategy vs. Liberal transfusion strategy (transfusions to maintain hemoglobin >= 10 g/dL) was evaluated on 30-day composite of death or myocardial infarction (p=0.60). Randomization to a restrictive versus liberal transfusion strategy resulted in comparable outcomes for the primary composite of 30-day death or myocardial infarction in both women and men (interaction P = 0.60).
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