Comparative Efficacy of Transfusion Strategies in Women and Men With Myocardial Infarction and Anemia: Prespecified Secondary Findings From the MINT Trial
Abstract
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 15.7% of women and 15.7% 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 mortality between 30 and 180 days (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.
Article Details
Authors (112)
J. Dawn Abbott
Jocelyne R. Benatar
Green Lane Clinical Coordinating Centre, Auckland, New Zealand (J.R.B., H.D.W.).
Colleen M. Ballantyne
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (C.M.B., B.M.H., M.B., M.M.B.).
Alice K. Jacobs
Boston University School of Medicine and Boston Medical Center, Boston, MA (A.K.J.).
Andrew M. Goldsweig
Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, MA (A.M.G.).
Dean A. Fergusson
University of Ottawa, Ottawa
Brandon M. Hebert
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (C.M.B., B.M.H., M.B., M.M.B.).
Marnie Bertolet
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (C.M.B., B.M.H., M.B., M.M.B.).
Tabassome Simon
French Alliance for Cardiovascular Trials, Paris
P. Gabriel Steg
Université Paris-Cité, Paris, France (P.G.S.).
Shaun G. Goodman
St. Michael’s Hospital, Unity Health Toronto, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (S.G.G.).
Harvey D. White
Green Lane Clinical Coordinating Centre, Auckland, New Zealand (J.R.B., H.D.W.).
Jeffrey L. Carson
Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.L.C.).
Maria M. Brooks
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (C.M.B., B.M.H., M.B., M.M.B.).
Conrado Estol
Marcelo Rugiero
Florencia Aguirre
Halina Navumava
Ruslan Yakubtsevich
Yury Holets
Marcelo Vianna Raffo
Alexandre Guerreiro
Daniel Thomas Pereira Lopes
Eduardo Estephan
Wilson Marques
Vera Bril
Xinghu Zhang
Fudong Shi
Dian He
Lan Chu
Chongbo Zhao
Yuwei Da
Qi Fang
State Key Laboratory of Rice Biology and Breeding and Ministry of Agriculture and Rural Affairs Key Laboratory of Molecular Biology of Crop Pathogens and Insect Pests and Zhejiang Key Laboratory of Biology and Ecological Regulation of Crop Pathogens and Insects, Institute of Insect Sciences, College of Agriculture and Biotechnology, Zhejiang University
Jing Li
Ting Chang
Sabrina Sacconi
Aleksandra Nadaj-Pakleza
Tim Hagenacker
Anirudha Apte
Rahul Baviskar
Arvind N. Prabhu, Praveen Kumar
Jayantee S. Kalita
Rahul Kulkarni
Surya Prabha Turaga
Rukmini Kandadai
Neeharika Lakshmi Mathukumalli
Sanjay Ramteke
Raffaele Iorio
Renato Emilio Mantegazza
Carlo Giuseppe Antozzi
Akiyuki Uzawa
Genya Watanabe
Yasushi Suzuki
Masako Suzuki
Takayuki Kondo
Andrzej Szczudlik
Anetta Lasek-Bal
Joanna Siuda
Małgorzata Zajda
Karolina Piasecka-Stryczynska
Russian Federation
Elena Parshina
Denis Korobko
Irina Poverennova
Evgeny Evdoshenko
Zoya Goncharova
Yury Trinitatskiy
Klara Bakhtiyarova
Inna Smagina
South Korea
Byoung Joon Kim
Ha Young Shin
Jeeyoung Oh
Alicia Martínez-Piñeiro
Eduardo Aguera Morales
Long-Sun Ro
Jiann-Horng Yeh
Hsueh-Wen Hsueh
Nai-Wen Tsai
Yuan-Ting Sun
Yi-Chung Lee
Chen-Chih Chung
Ayse Nur Yuceyar
Ihsan Sukru Sengun
Olga Shulga
Oleksandr Doroshenko
Sergii Moskovko
Oleksandr Kalbus
Aziz Shaibani
Waqar Waheed
Tuan Vu
Kelly G. Gwathmey
George A. Small
Ratna Bhavaraju-Sanka
Ali A. Habib
Urvi Desai
Yessar M. Hussain
Nicholas Streicher
Ryan Drake
Richard J. Nowak
Department of Neurology, Yale School of Medicine
Michael Benatar
University of Miami Miller School of Medicine, Miami
Emma Ciafaloni
University of Rochester, Rochester, NY
James F. Howard
University of North Carolina, Chapel Hill
M. Isabel Leite
University of Oxford, Oxford, United Kingdom
John Vissing
Rigshospitalet, University of Copenhagen, Copenhagen
Kimiaki Utsugisawa
Fred Lublin
Gary Cutter
Ken Sherman
John W. Baddley
Violeta Rus
Donald B. Sanders