Is the last bastion of blood transfusion falling?

Good Morning
 Today, we report the findings of a meta analysis evaluating the effect of blood transfusion on long term and short term outcomes amongst patients with STEMI. 

Red blood cell transfusion in patients with ST-elevation myocardial infarction—a meta-analysis of more than 21,000 patients.
Mincu R I et al
Neth Heart J (2018) 26:454–460

      The indications for transfusions in critically ill patients are narrowing down. More and more evidence seems to be pointing towards harm with liberal transfusion triggers. One of the subsets of patients where liberalism has been accepted is STEMI. It is hypothesized that lower Hb levels potentiate the genesis of ischemia and may be detrimental to the outcomes among patients with STEMI. Well designed RCTs evaluating transfusion triggers in STEMI are also understandably lacking.
       Mincu et al carried out a meta analysis "to determine the impact of RBT on short-term and long term outcomes in patients with STEMI, in order to address the gaps in knowledge in the management of these patients.
      In the absence of RCTs, 5 well designed high quality cohort studies were chosen for the meta analysis. More than 21000 patients were identified. 984 patients received transfusion. Patients who received transfusion had higher prevalence of DM and HTN. Previous MI, CABG and stroke rates were comparable between the two cohorts. Premorbid conditions seem to be higher in the cohort which received transfusions. The mean minimum Hb in the transfusion group was 8.5gm/dl. Patients who received transfusion had a higher in hospital mortality. The risk of long term mortality was also higher amongst patients with STEMI who received blood transfusions. More importantly, reinfarction rates were higher in those who received blood transfusions. More patients in the STEMI with transfusions progressed to heart failure. 

What I understood:
1. Comorbidities associated with lower Hb are often the triggers for transfusion.
2. Patients with STEMI with lower Hb levels do worse that those with higher Hb
3. Correcting the Hb with Blood transfusions does not confer any benefit.