Abstract Body (Do not enter title and authors here): Background: Chronic kidney disease (CKD) is associated with risk of myocardial infarction (MI) and anemia. Among patients with CKD and anemia who experience MI, it remains uncertain if a liberal transfusion threshold (LTT) strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (RTT, Hgb 7-8 g/dL) strategy.

Objectives: To evaluate outcomes of those with CKD randomized to RTT vs. LTT in the Myocardial Ischemia and Transfusion (MINT) trial (NCT02981407).

Methods: Among 3,495 MINT participants with non-missing creatinine (99.7%), we compared the baseline characteristics and outcomes at 30 days post-randomization of those individuals without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m² (N = 999), CKD with eGFR < 30 mL/min/1.73 m² (N = 802), and CKD requiring dialysis (N = 415), both overall and by randomized transfusion strategy. Interaction terms for eGFR category by treatment assignment on each outcome were assessed.

Results: Individuals with CKD compared to those without CKD more frequently presented with NSTEMI (all p < 0.001) and had a greater risk of all-cause death, recurrent MI, rehospitalization, and heart failure (all p < 0.05). Compared to a liberal transfusion strategy, a restrictive strategy among non-dialysis dependent individuals with an eGFR < 30 mL/min/1.73 m² was associated with an increased risk of death/recurrent MI (Figure 1) and unplanned rehospitalization (Figure 2). Among individuals with an eGFR 30-60 mL/min/1.73 m², a restrictive strategy was associated with an increased risk of cardiac death (Figure 1). No eGFR category by treatment assignment interaction terms were significant.

Conclusions: In this prespecified analysis, individuals with CKD were at greater risk of death, recurrent MI, heart failure, and unplanned rehospitalization at 30 days post-randomization than those without CKD. In individuals with CKD, a restrictive transfusion strategy was associated with increased risk of adverse outcomes.