RCT

MINT

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

NEJM, 2023 · Multicenter randomized trial (n=3504)

Clinical question

In acute MI with anemia, is a liberal RBC strategy superior to a restrictive strategy?

Population: Adults with acute myocardial infarction and hemoglobin <10 g/dL
Intervention: Liberal transfusion strategy targeting hemoglobin around >=10 g/dL
Comparator: Restrictive transfusion strategy with lower transfusion triggers
Primary outcome: 30-day myocardial infarction or death
Result: Primary outcome occurred in 14.5% with the liberal strategy vs 16.9% with the restrictive strategy; the difference did not reach conventional statistical significance, but clinically important harm from a restrictive strategy could not be excluded.

What the trial found

The trial did not prove superiority of the liberal strategy, but results favored it numerically and informed later ACS guidance.

Current guideline position

The 2025 ACC/AHA ACS guideline states that transfusion to maintain hemoglobin >=10 g/dL may be reasonable in ACS with anemia when not actively bleeding (Class 2b).

Clinical interpretation

Do not automatically apply the general ICU Hb 7 g/dL threshold to acute MI; individualize and consider the 2025 ACS guideline position.

Clinical Context & Relevant Topics (2)

Disease Reference

Blood Product Transfusion in Critical Care

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

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Acute Coronary Syndrome

Plaque rupture, coronary thrombosis, STEMI vs NSTEMI risk stratification, emergent reperfusion, DAPT/anticoagulation, and mechanical/electrical ICU complications.

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