MINt trial journal club presentation for JC

Mint trial journal club about importance of iron in healthcare and heart failure

1. Jeffrey L Carson, MD Study Chair and Principal Investigator Rutgers Robert Wood Johnson Medical School

2. Background Low blood count (Anemia) is common in patients with heart attack Normal hemoglobin level 13 in men, 12 in women Indications for red blood cell transfusion in heart attack patients are controversial Liberal transfusion- Transfuse at higher blood level - 10 Restrictive transfusion- Transfuse at lower blood levels-7-8 Trials in other clinical settings suggest use of restrictive transfusion is safe

3. Objective To determine whether the risk of death or MI differed using less blood transfusions and lower hemoglobin level of 7 to 8 as compared to using more blood transfusions with a hemoglobin level of 10 among patients with a heart attack and a blood count < 10

4. Methods Randomized controlled trial Eligibility: Heart attack and hemoglobin < 10 g/dL R estrictive strategy: transfusion permitted, but not required, when hemoglobin level < 7-8 Liberal strategy: give enough blood to maintain hemoglobin level ≥ 10 144 sites

5. Brazil 105 United States 2157 Canada 885 France 323 Australia 9 New Zealand 25

6. Baseline Characteristics Characteristic Restrictive (N=1749) Liberal (N=1755) Age in years, mean (SD) 72 72 Female (identity), n (%) 44% 47% White or Caucasian 78% 78% Black or African-American 14% 14% On ventilator 14% 13% Renal dialysis 12% 12%

7.     Primary Outcome P = 0.07

8. Secondary and Other Outcomes

9. Summary The MINT trial did not demonstrate a statistically significant difference in the rate of 30-day death or recurrent heart attacks in patients with heart attacks and anemia While not statistically significant, the results consistently favored a liberal transfusion strategy

10. Clinical Implications In contrast to other clinical settings, the trial results suggest that a liberal transfusion strategy has the potential for clinical benefit with low risk A liberal transfusion strategy may be the most prudent approach to transfusion in anemic patients with MI