{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:08:09Z","timestamp":1775646489633,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anemia is common in patients with acute myocardial infarction (AMI), and is an independent predictor of mortality. The optimal transfusion strategy in these patients is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>We hypothesized that a \u201crestrictive\u201d transfusion strategy (triggered by hemoglobin \u22648\u2009g\/dL) is clinically noninferior to a \u201cliberal\u201d transfusion strategy (triggered by hemoglobin \u226410\u2009g\/dL), but is less costly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>REALITY is an international, randomized, multicenter, open\u2010label trial comparing a restrictive vs a liberal transfusion strategy in patients with AMI and anemia. The primary outcome is the incremental cost\u2010effectiveness ratio (ICER) at 30\u2009days, using the primary composite clinical outcome of major adverse cardiovascular events (MACE; comprising all\u2010cause death, nonfatal stroke, nonfatal recurrent myocardial infarction, or emergency revascularization prompted by ischemia) as the effectiveness criterion. Secondary outcomes include the ICER at 1\u2009year, and MACE (and its components) at 30\u2009days and at 1\u2009year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The trial aimed to enroll 630 patients. Based on estimated event rates of 11% in the restrictive group and 15% in the liberal group, this number will provide 80% power to demonstrate clinical noninferiority of the restrictive group, with a noninferiority margin corresponding to a relative risk equal to 1.25. The sample size will also provide 80% power to show the cost\u2010effectiveness of the restrictive strategy at a threshold of \u20ac50\u2009000 per quality\u2010adjusted life year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>REALITY will provide important guidance on the management of patients with AMI and anemia.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23453","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T05:01:45Z","timestamp":1610082105000},"page":"143-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Restrictive vs liberal red blood cell transfusion strategies in patients with acute myocardial infarction and anemia: Rationale and design of the <scp>REALITY<\/scp> 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