Rationale and design for the myocardial ischemia and transfusion (MINT) randomized clinical trial
Department
Cardiology
Document Type
Article
Publication Title
American Heart Journal
Abstract
Background: Accumulating evidence from clinical trials suggests that a lower (restrictive) hemoglobin threshold (< 8% g/dL) for red blood cell (RBC) transfusion, compared with a higher (liberal) threshold (≥ 10 g/dL) is safe. However, in anemic patients with acute myocardial infarction (MI), maintaining a higher hemoglobin level may increase oxygen delivery to vulnerable myocardium resulting in improved clinical outcomes. Conversely, RBC transfusion may result in increased blood viscosity, vascular inflammation, and reduction in available nitric oxide resulting in worse clinical outcomes. We hypothesize that a liberal transfusion strategy would improve clinical outcomes as compared to a more restrictive strategy.
Methods: We will enroll 3500 patients with acute MI (type 1, 2, 4b or 4c) as defined by the Third Universal Definition of MI and a hemoglobin < 10 g/dL at 144 centers in the United States, Canada, France, Brazil, New Zealand, and Australia. We randomly assign trial participants to a liberal or restrictive transfusion strategy. Participants assigned to the liberal strategy receive transfusion of RBCs sufficient to raise their hemoglobin to at least 10 g/dL. Participants assigned to the restrictive strategy are permitted to receive transfusion of RBCs if the hemoglobin falls below 8 g/dL or for persistent angina despite medical therapy. We will contact each participant at 30 days to assess clinical outcomes and at 180 days to ascertain vital status. The primary end point is a composite of all-cause death or recurrent MI through 30 days following randomization. Secondary end points include all-cause mortality at 30 days, recurrent adjudicated MI, and the composite outcome of all-cause mortality, nonfatal recurrent MI, ischemia driven unscheduled coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting), or readmission to the hospital for ischemic cardiac diagnosis within 30 days. The trial will assess multiple tertiary end points.
Conclusions: The MINT trial will inform RBC transfusion practice in patients with acute MI.
First Page
120
Last Page
129
DOI
10.1016/j.ahj.2022.11.015
Volume
257
Publication Date
3-1-2023
PubMed ID
36417955
Recommended Citation
Carson, J. L., Brooks, M. M., Chaitman, B. R., Alexander, J. H., Goodman, S. G., Bertolet, M., Abbott, J. D., Cooper, H. A., Rao, S. V., Triulzi, D. J., Fergusson, D. A., Kostis, W. J., Noveck, H., Simon, T., Steg, P. G., DeFilippis, A. P., Goldsweig, A. M., Lopes, R. D., White, H., Alsweiler, C., Morton, E., Hébert, P. C., & Abtahian, F. (2023). Rationale and design for the myocardial ischemia and transfusion (MINT) randomized clinical trial. American Heart Journal, 257, 120-129. https://doi.org/10.1016/j.ahj.2022.11.015
Comments
Farhad Abtahian of Rochester Regional Health System is a contributor for this article.
See full list of authors and contributors at journal website.