Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.

The authors present the results of their pilot study for the Myocardial Ischemia and Transfusion (MINT) trial. The trial was conducted in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin < 10 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. The liberal transfusion strategy was associated with a trend towards fewer major cardiac events and deaths than a more restrictive strategy. While provocative, these results must be interpreted with caution, in view of the existing and conflicting literature and of the small number of patients enrolled. Remember, the pilot study to FOCUS also showed an increase in mortality (trend) that did not bear out in the final study. However, this pilot trial does tell us that such a study is feasible and that its results will be essential for the management of patients of patients with myocardial ischemia. We all look forward to the results of the main MINT trial. Jean-François Hardy