Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, NEJMoa2307983. https://doi.org/10.1056/NEJMoa2307983 Dr. Jeffrey L. Carson et al.
Points
- A phase 3 interventional trial compared a restrictive transfusion strategy (hemoglobin cutoff of 7 or 8 g/dL) with a liberal transfusion strategy (hemoglobin cutoff of <10 g/dL) in patients with acute myocardial infarction (AMI) and anemia.
- The study included 3504 patients and found that the mean number of red-cell units transfused was significantly lower in the restrictive-strategy group (0.7±1.6) compared to the liberal-strategy group (2.5±2.3).
- The primary outcome, a composite of myocardial infarction or death at 30 days, did not significantly differ between the two groups (16.9% in the restrictive-strategy group vs. 14.5% in the liberal-strategy group).
- Rates of death and myocardial infarction were similar between the two groups, suggesting that a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days in anemic patients with AMI.
- The study highlights the need for further research and consideration to determine the optimal transfusion strategy for this patient population.
Summary
This phase 3 interventional trial aimed to assess the effect of transfusion strategy on myocardial infarction (MI) and mortality in patients with acute myocardial infarction (AMI) and anemia. A total of 3504 patients with AMI and a hemoglobin level below 10 g per deciliter were randomly assigned to either a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of MI or death at 30 days.
The study found that the mean number of red-cell units transfused was significantly lower in the restrictive-strategy group (0.7±1.6) compared to the liberal-strategy group (2.5±2.3). The mean hemoglobin level was also consistently lower in the restrictive-strategy group during the first three days after randomization. However, there was no significant difference in the occurrence of the primary outcome between the two groups (16.9% in the restrictive-strategy group vs. 14.5% in the liberal-strategy group, risk ratio 1.15, 95% CI 0.99 to 1.34, P=0.07). The rates of death and MI were also similar between the two groups.
Based on these findings, a liberal transfusion strategy did not significantly reduce the risk of recurrent MI or death at 30 days in anemic patients with AMI. However, the study acknowledges that potential harms associated with a restrictive transfusion strategy cannot be excluded. Further research and consideration are needed to determine the optimal transfusion strategy for this patient population.
Link to the article: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2307983
References Carson, J. L., Brooks, M. M., Hébert, P. C., Goodman, S. G., Bertolet, M., Glynn, S. A., Chaitman, B. R., Simon, T., Lopes, R. D., Goldsweig, A. M., DeFilippis, A. P., Abbott, J. D., Potter, B. J., Carrier, F. M., Rao, S. V., Cooper, H. A., Ghafghazi, S., Fergusson, D. A., Kostis, W. J., … Alexander, J. H. (2023). Restrictive or liberal transfusion strategy in myocardial infarction and anemia. New England Journal of Medicine, NEJMoa2307983. https://doi.org/10.1056/NEJMoa2307983
