Authors of a paper published in JAMA Internal Medicine performed a secondary analysis of the Myocardial Ischemia and Transfusion (MINT) randomized trial. They sought to, “determine if a liberal transfusion strategy compared with a restrictive transfusion strategy affected 30-day post-randomization quality of life (QOL).” Prior results from the MINT trial published in 2023 found that, “in patients with acute myocardial infarction and anemia, a liberal blood transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. Trial end points suggest[ed] some benefit of a liberal blood transfusion strategy over a restrictive blood transfusion strategy, but additional studies would be needed to confirm that conclusion.”
The investigators of the secondary analysis have reported that, “[o]ur primary analysis did not demonstrate any significant difference in health-related QOL 30 days after randomization by keeping Hb levels above 10 g/dL in the liberal transfusion strategy group compared with lower Hb levels in the restrictive transfusion strategy group. This suggests that higher Hb levels maintained with red blood cell (RBC) transfusion may not offer significant benefits to QOL in patients with myocardial ischemia (MI) and anemia. [Additionally,] confidence in the finding from the primary analysis that transfusion does not affect overall QOL in the population at 30 days should be high. The results also have significant practice implications and suggest that the transfusion strategy during hospitalization for patients with acute MI and anemia does not influence post-discharge QOL as an important clinical outcome.”
The authors of the secondary analysis wrote in the paper that limitations included, “the present analyses may be underpowered and vulnerable to biases, and the results may not be generalizable to the entire MINT trial cohort. In addition, QOL was not assessed at baseline, and so we are unable to determine whether it changed with or without transfusion. Multiple subgroups were analyzed in this study, which increases the chance that some of the positive findings could be false positives (type 1 error)…[W]e only measured QOL once 30 days post-randomization, and we may have missed either earlier or more nuanced intermittent changes in QOL that can occur over time.”
Citation: Prochaska, M., Portela, G., Brooks, M., et al. “Transfusion Strategy Effect on Quality of Life in Patients With Myocardial Infarction and Anemia: A Secondary Analysis of the MINT Randomized Clinical Trial.” JAMA Internal Medicine. 2025.