Effect of Four Hemoglobin Transfusion Threshold Strategies in Patients With Acute Myocardial Infarction and Anemia : A Target Trial Emulation Using MINT Trial Data.

Autor:	Portela GT; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (G.T.P., S.A.S.)., Carson JL; Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.)., Swanson SA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (G.T.P., S.A.S.)., Alexander JH; Duke Clinical Research Institute, Duke University, Durham, North Carolina (J.H.A., R.D.L.)., Hébert PC; Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada (P.C.H.)., Goodman SG; St. Michael's Hospital, Unity Health Toronto, and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada, and Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (S.G.G.)., Steg PG; Université Paris-Cité and French Alliance for Cardiovascular Trials (FACT), Paris, France (P.G.S.)., Bertolet M; Department of Epidemiology and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (M.B., M.M.B.)., Strom JB; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (J.B.S.)., Fergusson DA; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.A.F.)., Simon T; French Alliance for Cardiovascular Trials (FACT); Sorbonne Université; and Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pharmacologie, Plateforme de Recherche, Clinique de l'Est Parisien, Hospital Saint Antoine, Paris, France (T.S.)., White HD; Green Lane Clinical Coordinating Centre, Auckland, New Zealand (H.D.W.)., Cooper HA; Department of Cardiology, Westchester Medical Center, Valhalla, New York (H.A.C.)., Abbott JD; Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island (J.D.A.)., Rao SV; Department of Medicine, NYU Langone Health System, New York, New York (S.V.R.)., Chaitman BR; Division of Cardiology, St. Louis University School of Medicine, St. Louis, Missouri (B.R.C.)., Fordyce CB; Division of Cardiology, Vancouver General Hospital, and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada (C.B.F.)., Lopes RD; Duke Clinical Research Institute, Duke University, Durham, North Carolina (J.H.A., R.D.L.)., Daneault B; Université de Sherbrooke, Sherbrooke, Quebec, Canada (B.D.)., Brooks MM; Department of Epidemiology and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (M.B., M.M.B.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2024 Nov; Vol. 177 (11), pp. 1489-1498. Date of Electronic Publication: 2024 Oct 01.
DOI:	10.7326/M24-0571
Abstrakt:	Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain. Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia. Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods. (ClinicalTrials.gov: NCT02981407). Setting: 144 clinical sites in 6 countries. Participants: 3492 MINT trial participants with acute MI and a hemoglobin level below 10 g/dL. Intervention: Four transfusion strategies to maintain patients' hemoglobin concentrations at or above thresholds of 10, 9, 8, or 7 g/dL. Protocol exceptions were permitted for specified adverse clinical events. Measurements: Data from the MINT trial were leveraged to emulate 4 transfusion strategies and estimate per protocol effects on the composite outcome of 30-day death or recurrent MI (death/MI) and 30-day death using inverse probability weighting. Results: The 30-day risk for death/MI was 14.8% (95% CI, 11.8% to 18.4%) for a <10-g/dL strategy, 15.1% (CI, 11.7% to 18.2%) for a <9-g/dL strategy, 15.9% (CI, 12.4% to 19.0%) for a <8-g/dL strategy, and 18.3% (CI, 14.6% to 22.0%) for a <7-g/dL strategy. Absolute risk differences and risk ratios relative to the <10-g/dL strategy for 30-day death/MI increased as thresholds decreased, although 95% CIs were wide. Findings were similar and imprecise for 30-day death. Limitation: Unmeasured confounding may have persisted despite adjustment. Conclusion: The 30-day risks for death/MI and death among patients with acute MI and anemia seem to increase progressively with lower hemoglobin concentration thresholds for transfusion. However, the imprecision around estimates from this target trial analysis precludes definitive conclusions about individual hemoglobin thresholds. Primary Funding Source: National Heart, Lung, and Blood Institute. Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0571.
Databáze:	MEDLINE
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