Work

A comprehensive set of per-protocol analyses of the myocardial ischemia and transfusion (MINT) trial

Year: 2026

Type: article

Abstract: • Adherence to the assigned transfusion strategy was higher in the restrictive than the liberal transfusion strategy group. • Patients who adhered to the assigned transfusion strategy tended to be lower risk than patients who did not adhere. • In a range of per-protocol analyses, patients receiving a liberal transfusion strategy had lower rates of death or MI and death than patients receiving a restrictive transfusion strategy. • Instrumental variable analysis results were consistent with the intention-to-treat findings We conducted a series of analyses to estimate the per-protocol effect of restrictive versus liberal transfusion strategies on 30-day death and death or recurrent myocardial infarction (MI) among patients from the Myocardial Ischemia and Transfusion (MINT) trial. Multiple analytic approaches were used to estimate the per-protocol effect, including analyses based on different definitions of adherence (site-reported, time-based, transfusion delay) and an instrumental variable analysis. Analyses based on adherence definitions found a restrictive strategy was associated with a substantially greater risk of 30-day death or recurrent MI, while the instrumental variable analysis estimated a moderate treatment effect similar to the original ITT result.

Source: American Heart Journal

DOI: 10.1016/j.ahj.2026.107382