Cardiology in critical care · Transfusion after myocardial infarction
Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia
| Design | Phase 3 randomised controlled trial |
|---|---|
| Treatment | Liberal transfusion strategy, haemoglobin threshold 10 g/dL |
| Control | Restrictive transfusion strategy, threshold 7 to 8 g/dL |
| Population | 3504 patients with acute myocardial infarction and anaemia |
| Follow-up | 30 days |
| Primary endpoint | Recurrent myocardial infarction or death at 30 days |
| Result | Mean red-cell units transfused were 0.7±1.6 in the restrictive group and 2.5±2.3 in the liberal group. The liberal strategy did not significantly reduce recurrent myocardial infarction or death at 30 days, though the authors note potential harms of the restrictive approach could not be excluded. |
| Secondary endpoints | Death, recurrent infarction, heart failure, cardiac death |
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.
The trial authors, in the published abstract
An unusually candid conclusion: the trial is formally negative and the authors decline to declare the restrictive strategy safe. Point estimates favoured liberal transfusion, and many cardiologists transfuse at a higher threshold after infarction on that basis. Compare REALITY, which reached non-inferiority.
Carson JL, Brooks MM, Hébert PC, et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med 2023 Dec 28;389(26):2446-2456.