473. ACS Guidelines Question #11 with Dr. Venu Menon

Managing anemia in patients with Acute Coronary Syndrome (ACS) requires balancing clinical outcomes with resource stewardship, as highlighted by the 2025 ACS Guidelines. While restrictive transfusion strategies targeting hemoglobin levels of 7–8 g/dL are standard in general intensive care, the MINT trial suggests a potential short-term clinical benefit from a liberal strategy targeting ≥10 g/dL in ACS populations. Specifically, the trial showed a signal toward reduced cardiac death in the liberal arm, despite the primary endpoint of 30-day death or recurrent MI not reaching statistical significance. Consequently, the guidelines offer a Class 2B recommendation for liberal transfusion. Dr. Venu Menon, a member of the guidelines writing committee, emphasizes a nuanced, case-by-case approach: prioritizing liberal transfusion for patients with active ischemia or unstable substrates, while exercising judicial restraint for stable, revascularized patients to preserve precious blood bank resources.