# Myocardial Ischemia and Transfusion (MINT) - DCC

> **NIH NIH U01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $770,534

## Abstract

PROJECT SUMMARY
Accumulating evidence from clinical trials suggests that a restrictive transfusion strategy is safe in most clinical
settings. However, a low oxygen carrying capacity from moderate anemia may be deleterious in patients with
cardiac ischemia. The potential for harm associated with anemia in patients with acute symptomatic coronary
disease is supported by pathophysiological data that maintaining higher hemoglobin levels could benefit the
ischemic heart by increasing oxygen delivery. Furthermore, results of the 110 patient MINT pilot trial found
that all-cause mortality at 30 days was less frequent with a liberal transfusion strategy, 1 patient (1.8%),
compared with a restrictive transfusion strategy, 7 patients (13.0%), (p=0.032). Systematic reviews of clinical
trials evaluating transfusion strategies in patients with known ischemic heart disease document the absence of
high quality data which has resulted in an ongoing controversy. The lack of high quality evidence to guide
transfusions in patients with acute myocardial infarction has been cited in several major guidelines as well as
by an NIH expert panel. Despite this, blood transfusions are being used as a negative indicator of quality of
care by major organizations driving the adoption of restrictive strategies. The potential for adverse outcomes is
real and immediate.
In this multicenter pragmatic trial, we will activate 40 clinical centers and will randomly allocate 3500 patients at
risk of myocardial ischemia with acute myocardial infarction and hemoglobin concentration less than 10 g/dL to
be treated either according to a restrictive or liberal blood transfusion strategy. Our Primary Aim will be to
determine whether a liberal transfusion threshold strategy (10 g/dL) is superior and will result in lower rates of
either all cause mortality or acute myocardial infarction within 30 days following randomization as compared
with a restrictive transfusion threshold strategy (8 g/dL). Our secondary aims will examine the effect of a liberal
transfusion strategy compared with a restrictive transfusion strategy on adverse outcomes of transfusion
related to volume overload, thrombotic risk and modified immunity. We will compare 30-day rates of
congestive heart failure, thromboembolism, and pneumonia. We will also compare rates of 30-day death,
cardiovascular death, myocardial infarction, and unscheduled revascularization, as well as hospital length of
stay, and readmission to the hospital. We will contact the patients at 6 months to determine if the early effects
on mortality are sustained or possibly enhanced.
Relevance
MINT is positioned to determine the threshold for blood transfusions in patients with acute myocardial infarction
to minimize death and subsequent heart attacks. Given the high incidence of acute myocardial infarction, the
results of MINT can shape clinical practice.

## Key facts

- **NIH application ID:** 9932173
- **Project number:** 5U01HL132853-05
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Maria Mori Brooks
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $770,534
- **Award type:** 5
- **Project period:** 2016-09-01 → 2022-09-26

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9932173

## Citation

> US National Institutes of Health, RePORTER application 9932173, Myocardial Ischemia and Transfusion (MINT) - DCC (5U01HL132853-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9932173. Licensed CC0.

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