2023Acute coronary syndromes3504 patients

MINT

Therapy group: Transfusion · Therapy: Restrictive vs liberal transfusion

In myocardial infarction with anemia, a liberal transfusion strategy did not significantly reduce 30-day death or reinfarction versus a restrictive strategy, though a favorable trend was seen.

Published in N Engl J Med (2023)

Question: In patients with acute myocardial infarction and anemia, is a liberal transfusion strategy superior to a restrictive one in reducing reinfarction or death?
Design: Phase 3, randomized, single-masked trial comparing two transfusion strategies; 3504 patients were included in the primary analysis.
Population: Patients with myocardial infarction and a hemoglobin level below 10 g/dL.
Intervention: Liberal strategy: red-cell transfusion with a hemoglobin threshold below 10 g/dL; per the registry, one unit was given after randomization, followed by enough units to keep hemoglobin above that level.
Control: Restrictive strategy: transfusion permitted at a hemoglobin threshold of 7 or 8 g/dL, according to physician judgment.
Primary outcome: Composite of myocardial infarction or death at 30 days.
Results: A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive group and 255 of 1755 (14.5%) in the liberal group (risk ratio 1.15; 95% CI 0.99 to 1.34; P = 0.07). Death occurred in 9.9% and 8.3%, respectively (RR 1.19; 95% CI 0.96 to 1.47).
Conclusion: A liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days, although potential harms of a restrictive strategy cannot be excluded.
Why it matters: The trial provided randomized evidence in an area of marked uncertainty and suggested that a more restrictive transfusion approach in myocardial infarction with anemia may not be harmless, fueling debate over the optimal hemoglobin threshold.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 14, 2026

Sources

Original publication on PubMed (PMID 37952133) ↗Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT02981407) ↗

Videos explaining it

MINT Results

AHA · AHAScience ↗14:47Video page

Source: AHAScience · YouTube
Date: 12 Nov 2023
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

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