Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.

Jeffrey L. Carson; Maria Mori Brooks; Paul C. Hébert; Shaun G. Goodman; Marnie Bertolet; Simone A. Glynn; Bernard R. Chaitman; Tabassome Simon; Renato D. Lopes; Andrew M. Goldsweig; Andrew P. Defilippis; J. Dawn Abbott; Brian J. Potter; Francois Martin Carrier; Sunil V. Rao; Howard A. Cooper; Shahab Ghafghazi; Dean A. Fergusson; William J. Kostis; Helaine Noveck; Sarang Kim; Meechai Tessalee; Gregory Ducrocq; Pedro Gabriel Melo De Barros E Silva; Darrell J. Triulzi; Caroline Alsweiler; Mark A. Menegus; John D. Neary; Lynn Uhl; Jordan B. Strom; Christopher B. Fordyce; Emile Ferrari; Johanne Silvain; Frances O. Wood; Benoit Daneault; Tamar S. Polonsky; Manohara Senaratne; Etienne Puymirat; Claire Bouleti; Benoit Lattuca; Harvey D. White; Sheryl F. Kelsey; P. Gabriel Steg; John H. Alexander

doi:10.1056/NEJMoa2307983

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.

Jeffrey L. Carson, Maria Mori Brooks, Paul C. Hébert, Shaun G. Goodman, Marnie Bertolet, Simone A. Glynn, Bernard R. Chaitman, Tabassome Simon, Renato D. Lopes, Andrew M. Goldsweig, Andrew P. Defilippis, J. Dawn Abbott, Brian J. Potter, Francois Martin Carrier, Sunil V. Rao, Howard A. Cooper, Shahab Ghafghazi, Dean A. Fergusson, William J. Kostis, Helaine NoveckSarang Kim, Meechai Tessalee, Gregory Ducrocq, Pedro Gabriel Melo De Barros E Silva, Darrell J. Triulzi, Caroline Alsweiler, Mark A. Menegus, John D. Neary, Lynn Uhl, Jordan B. Strom, Christopher B. Fordyce, Emile Ferrari, Johanne Silvain, Frances O. Wood, Benoit Daneault, Tamar S. Polonsky, Manohara Senaratne, Etienne Puymirat, Claire Bouleti, Benoit Lattuca, Harvey D. White, Sheryl F. Kelsey, P. Gabriel Steg, John H. Alexander

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

Abstract Background A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. Methods In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. Results A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). Conclusions In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)

Original language	English (US)
Pages (from-to)	2446-2456
Number of pages	11
Journal	New England Journal of Medicine
Volume	389
Issue number	26
DOIs	https://doi.org/10.1056/NEJMoa2307983
State	Published - Dec 28 2023
Externally published	Yes

Keywords

Anemia
Cardiology
Coronary Disease/Myocardial Infarction
Hematology/Oncology

ASJC Scopus subject areas

General Medicine

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10.1056/NEJMoa2307983

Cite this

Carson, J. L., Brooks, M. M., Hébert, P. C., Goodman, S. G., Bertolet, M., Glynn, S. A., Chaitman, B. R., Simon, T., Lopes, R. D., Goldsweig, A. M., Defilippis, A. P., Abbott, J. D., Potter, B. J., Carrier, F. M., Rao, S. V., Cooper, H. A., Ghafghazi, S., Fergusson, D. A., Kostis, W. J., ... Alexander, J. H. (2023). Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. New England Journal of Medicine, 389(26), 2446-2456. https://doi.org/10.1056/NEJMoa2307983

Carson, JL, Brooks, MM, Hébert, PC, Goodman, SG, Bertolet, M, Glynn, SA, Chaitman, BR, Simon, T, Lopes, RD, Goldsweig, AM, Defilippis, AP, Abbott, JD, Potter, BJ, Carrier, FM, Rao, SV, Cooper, HA, Ghafghazi, S, Fergusson, DA, Kostis, WJ, Noveck, H, Kim, S, Tessalee, M, Ducrocq, G, De Barros E Silva, PGM, Triulzi, DJ, Alsweiler, C, Menegus, MA, Neary, JD, Uhl, L, Strom, JB, Fordyce, CB, Ferrari, E, Silvain, J, Wood, FO, Daneault, B, Polonsky, TS, Senaratne, M, Puymirat, E, Bouleti, C, Lattuca, B, White, HD, Kelsey, SF, Steg, PG & Alexander, JH 2023, 'Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.', New England Journal of Medicine, vol. 389, no. 26, pp. 2446-2456. https://doi.org/10.1056/NEJMoa2307983

@article{ed5fc06df6204abe92bb3166c920fcfb,

title = "Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.",

abstract = "Abstract Background A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. Methods In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. Results A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). Conclusions In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)",

keywords = "Anemia, Cardiology, Coronary Disease/Myocardial Infarction, Hematology/Oncology",

author = "Carson, {Jeffrey L.} and Brooks, {Maria Mori} and H{\'e}bert, {Paul C.} and Goodman, {Shaun G.} and Marnie Bertolet and Glynn, {Simone A.} and Chaitman, {Bernard R.} and Tabassome Simon and Lopes, {Renato D.} and Goldsweig, {Andrew M.} and Defilippis, {Andrew P.} and Abbott, {J. Dawn} and Potter, {Brian J.} and Carrier, {Francois Martin} and Rao, {Sunil V.} and Cooper, {Howard A.} and Shahab Ghafghazi and Fergusson, {Dean A.} and Kostis, {William J.} and Helaine Noveck and Sarang Kim and Meechai Tessalee and Gregory Ducrocq and {De Barros E Silva}, {Pedro Gabriel Melo} and Triulzi, {Darrell J.} and Caroline Alsweiler and Menegus, {Mark A.} and Neary, {John D.} and Lynn Uhl and Strom, {Jordan B.} and Fordyce, {Christopher B.} and Emile Ferrari and Johanne Silvain and Wood, {Frances O.} and Benoit Daneault and Polonsky, {Tamar S.} and Manohara Senaratne and Etienne Puymirat and Claire Bouleti and Benoit Lattuca and White, {Harvey D.} and Kelsey, {Sheryl F.} and Steg, {P. Gabriel} and Alexander, {John H.}",

note = "Publisher Copyright: {\textcopyright} 2023 Massachusetts Medical Society.",

year = "2023",

month = dec,

day = "28",

doi = "10.1056/NEJMoa2307983",

language = "English (US)",

volume = "389",

pages = "2446--2456",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "26",

}

TY - JOUR

T1 - Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.

AU - Carson, Jeffrey L.

AU - Brooks, Maria Mori

AU - Hébert, Paul C.

AU - Goodman, Shaun G.

AU - Bertolet, Marnie

AU - Glynn, Simone A.

AU - Chaitman, Bernard R.

AU - Simon, Tabassome

AU - Lopes, Renato D.

AU - Goldsweig, Andrew M.

AU - Defilippis, Andrew P.

AU - Abbott, J. Dawn

AU - Potter, Brian J.

AU - Carrier, Francois Martin

AU - Rao, Sunil V.

AU - Cooper, Howard A.

AU - Ghafghazi, Shahab

AU - Fergusson, Dean A.

AU - Kostis, William J.

AU - Noveck, Helaine

AU - Kim, Sarang

AU - Tessalee, Meechai

AU - Ducrocq, Gregory

AU - De Barros E Silva, Pedro Gabriel Melo

AU - Triulzi, Darrell J.

AU - Alsweiler, Caroline

AU - Menegus, Mark A.

AU - Neary, John D.

AU - Uhl, Lynn

AU - Strom, Jordan B.

AU - Fordyce, Christopher B.

AU - Ferrari, Emile

AU - Silvain, Johanne

AU - Wood, Frances O.

AU - Daneault, Benoit

AU - Polonsky, Tamar S.

AU - Senaratne, Manohara

AU - Puymirat, Etienne

AU - Bouleti, Claire

AU - Lattuca, Benoit

AU - White, Harvey D.

AU - Kelsey, Sheryl F.

AU - Steg, P. Gabriel

AU - Alexander, John H.

PY - 2023/12/28

Y1 - 2023/12/28

N2 - Abstract Background A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. Methods In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. Results A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). Conclusions In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)

AB - Abstract Background A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. Methods In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. Results A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). Conclusions In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)

KW - Anemia

KW - Cardiology

KW - Coronary Disease/Myocardial Infarction

KW - Hematology/Oncology

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U2 - 10.1056/NEJMoa2307983

DO - 10.1056/NEJMoa2307983

M3 - Article

C2 - 37952133

AN - SCOPUS:85178196340

SN - 0028-4793

VL - 389

SP - 2446

EP - 2456

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 26

ER -

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.

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