JAMA Network Open · IF 10.5 · July 27, 2026 · LoE I
Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction
M Bertolet, François Martin Carrier, Glynn, Simone, 1960-, J. Dawn Abbott, Andrew P. DeFilippis, Tabassome Simon, C B Fordyce, Senaratne Jw, Brian J. Potter, Brandon M. Herbert, Sunil V. Rao, Adriano Caixeta — University of Pittsburgh
This is a post hoc Bayesian reanalysis of the MINT trial, which randomized 3504 patients with myocardial infarction and anemia to a restrictive (transfuse below Hgb 7-8 g/dL) versus liberal (keep Hgb above 10 g/dL) transfusion strategy. The original frequentist result for 30-day death or MI was borderline (crude risk ratio 1.16, 95% CI 1.00-1.35, with 16.9% events in the restrictive arm vs 14.5% in the liberal arm), so the authors reanalyzed the same data using Bayesian methods and found an 89.1% to 98.8% posterior probability that the liberal strategy reduced death or MI, at the cost of a modestly higher (60.6%-80.0% probability) risk of heart failure.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersAnemic MI patients are common in both cardiology and perioperative orthopedic settings, and this reanalysis illustrates how a 'negative' P=.07 trial can be reframed as supportive evidence using Bayesian statistics, a distinction trainees should recognize when reading transfusion literature.
Conclusion strengthConfirms prior evidence
The conclusions are not supported by the reported results.
Presenting this at rounds? Start here
- ?For an anemic patient with a recent MI who needs orthopedic surgery, should the perioperative transfusion threshold be raised toward 10 g/dL despite the small added heart failure risk this analysis suggests?
- ?How should surgeons weigh a borderline (P=.07) frequentist trial result against a Bayesian reanalysis suggesting high probability of benefit when deciding transfusion thresholds for their own anemic surgical patients?