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Herz

, Volume 22, Supplement 1, pp 73–76 | Cite as

Acute myocardial infarction without thrombolytic therapy: Beneficial effects of magnesium sulfate

  • M. Shechter
  • H. Hod
  • P. Chouraqui
  • E. Kaplinsky
  • B. Rabinowitz
Article

Summary

Only one third of hospitalized patients with acute myocardial infarction (AMI) receive thrombolytic therapy despite its proven benefits on outcomes. Elderly patients, have a greater risk of death during myocardial infarction; however, thrombolytic therapy appears to be less used in these patients, as compared to the general AMI-patients. In order to evaluate the impact of magnesium supplementation in AMI-patients without thrombolytic therapy, 194 patients participated in a prospective, randomized and placebo-controlled study: 96 patients received a 48-hour intravenous magnesium sulfate and 98 isotonic glucose as placebo. Magnesium infusion reduced the incidence of arrhythmias, congestive heart failure and in-hospital-mortality compared with placebo (27 vs. 40%, p=0.04; 18 vs. 23%, p=0.27; 4 vs. 17%, p<0.01, respectively); in the subgroup of elderly patients (>70 years), the benefit was also obvious (42 vs. 50%; 18 vs. 25%; 9 vs. 23%, p=0.09, respectively). These data suggest that intravenous magnesium supplementation might be justified in order to reduce myocardial damage and mortality rate in subsets of high-risk patients such the elderly and/or patients not suitable for thrombolysis. Additional trials appear to be indicated to evaluate the potential benefit of magnesium in well defined specific subsets of AMT-patients.

Keywords

Magnesium Acute Myocardial Infarction Acute Myocardial Infarction Thrombolytic Therapy Magnesium Sulfate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Akuter Myokardinfarkt ohne thrombolytische Therapie: Vorteilhafte Wirkungen von Magnesiumsulfat

Zusammenfassung

Nur ein Drittel aller Krankenhauspatienten mit akutem Myokardinfarkt (AMI) wird trotz der erwiesenen Vorteile für die Ergebnisse thrombolytisch behandelt. Bei älteren Patienten besteht eine größere Sterblichkeitsgefahr bei Myokardinfarkten, jedoch scheint bei diesen Patienten im Vergleich zu allgemeinen AMI-Patienten die thrombolytische Therapie weniger angewandt zu werden.

Um die Wirkung von Magnesiumsupplementierung bei AMI-Patienten ohne thrombolytische Therapie zu beurteilen, nahmen 194 Patienten an einer prospektiven, randomisierten, placebokontrollierten Untersuchung teil. 96 Patienten wurde im Verlauf von 48 Stunden intravenös Magnesiumsulfat verabreicht und 98 Patienten isotonische Glucose als Placebo. Die Magnesiuminfusionen minderten das Auftreten von Arrhythmien, Stauungsherzinsuffizienz und die Sterblichkeit während des Krankenhausaufenthalts im Vergleich zum Placebo (27 im Vergleich zu 40%, p=0,04; 18 im Vergleich zu 23%, p=0,27 bzw. 4 im Vergleich zu 17%, p<0,01). In der Untergruppe mit älteren Patienten (>70 Jahre) waren die Vorteile ebenfalls offensichtlich (42 im Vergleich zu 50%; 18 im Vergleich zu 25% bzw. 9 im Vergleich zu 23%, p=0,09). Diese Daten lassen vermuten, daß intravenöse Magnesiumsupplementierung gerechtfertigt ist, um Myokardschäden und Sterblichkeit in kleinen Gruppen stark gefährdeter Patienten wie ältere bzw. Patienten, die sich nicht für Thrombolyse eignen, zu mindern. Zusätzliche Versuche scheinen angezeigt zu sein, um die möglichen Vorteile von Magnesium in gut umrissenen spezifischen kleineren AMI-Patientengruppen zu bewerten.

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References

  1. 1.
    Althouse, R., C. Maynard, M. D. Cerguiera, M. Olsuflca, J. L. Ritchie, J. W. Kennedy: The Western Washington Myocardial Infarction Registry and Emergency Department Tissue Plasminogen Activator Treatment Trial. Amer. J. Cardiol. 66 (1990), 1298–1303.PubMedCrossRefGoogle Scholar
  2. 2.
    Antman, E. M.: Magnesium in acute myocardial infarction: Overview of available evidence. Amer. Heart J. 132 (1996), 487–494.PubMedCrossRefGoogle Scholar
  3. 3.
    Antman, E. M: Magnesium in acute MI: timing is critical. Circulation 92 (1995), 2367–2372.PubMedGoogle Scholar
  4. 4.
    Arsenian, M. A.: Magnesium and cardiovascular disease. Progr. cardiovasc. Dis. 35 (1993), 271–310.CrossRefGoogle Scholar
  5. 5.
    Behar, S., E. Abinader, A. Caspi, D. David, M. Flich, Y. Friedman, H. Hod, E. Kaplinsky, Y. Kishon, N. Kristal: Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel. Amer. J. Cardiol. 68 (1991), 1291–1294.PubMedCrossRefGoogle Scholar
  6. 6.
    De Vreede, J. J. M., A. P. M. Gorgels, G. M. P. Verstraaten, F. Vermeer, W. R. M. Dassen, H. J. J. Wellens: Did prognosis after acute myocardial infarction change during the past 30 years? A meta-analysis. J. Amer. Coll. Cardiol. 18 (1991), 698–706.Google Scholar
  7. 7.
    Frandsen, N. J., K. Winther, F. Pedersen, I. Christansen, P. McNair: Magnesium and platelet function: In vivo influence on aggregation and alpha-granule release in healthy volunteers. Magn. Bull. 17 (1995), 37–40.Google Scholar
  8. 8.
    Grindler, E. M., D. A. Heath: Chlorimetric determination with bound “calmagite” of magnesium in human blood serum. Clin. Chem. 17 (1971), 662–664.Google Scholar
  9. 9.
    Gurwitz, J. H., J. M. Gore, R. J. Goldberg, M. Rubison, N. Chandra, W. J. Rogers: Recent age-related trends in the use of thrombolytic therapy in patients who have had acute myocardial infarction. Ann. intern. Med. 124 (1996), 283–291.PubMedGoogle Scholar
  10. 10.
    Herzog, W. R., D. Atar, I. T. Mak, D. Alyono, C. MacCord, W. B. Weglicki: Magnesium deficiency prolongs myocardial stunning in an open-chest swine model. Int. J. Cardiol. 47 (1955), 105–115.CrossRefGoogle Scholar
  11. 11.
    Horner, S. M.: Efficiancy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Metaanalysis of magnesium in acute myocardial infarction. Circulation 86 (1992), 774–779.PubMedGoogle Scholar
  12. 12.
    Hwang, D. L., C. F. Yen, J. L. Nadler: Effect of extracellular magnesium on platelet activation and intracellular calcium mobilization. Amer. J. Hypertens. 5 (1992), 700–706.Google Scholar
  13. 13.
    Iseri, L. T, J. H. French: Magnesium: nature’s physiologic calcium blocker. Amer. Heart J. 108 (1984), 188–193.PubMedCrossRefGoogle Scholar
  14. 14.
    ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58050 patients with suspected acute myocardial infarction. Lancet 345 (1995), 669–685.CrossRefGoogle Scholar
  15. 15.
    Leor, J., R. A. Kloner: An experimental model examining the role of magnesium in the therapy of acute myocardial infarction. Amer. J. Cardiol. 75 (1955), 1292–1293.Google Scholar
  16. 16.
    Maggioni, A. P., A. Maseri, C. Fresco, M. Franzosi, F. Mauri, E. Santoro, G. Tognoni: Age-related increase in mortality among patients with first myocardial infarction treated with thrombolysis. New Engl. J. Med. 329 (1993), 1442–1448.PubMedCrossRefGoogle Scholar
  17. 17.
    Maynard, C., D. Weaver, P. E. Litwin, J. S. Martin, P. J. Kudenchuk, T. A. Dewhurst, M. S. Eisenberg, A. P. Hallstrom, J. Chambers, for the MITI Project Investigators: Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the Myocardial Infarction Trial and Intervention Project). Amer. J. Cardiol. 72 (1993), 877–882.PubMedCrossRefGoogle Scholar
  18. 18.
    Mroczek, W. J., W. R. Lee, M. E. Davidov: Effect of magnesium sulfate on cardiovascular hemodynamics. Angiology 28 (1977), 720–724.PubMedCrossRefGoogle Scholar
  19. 19.
    Naylor, C. D., E. Chen: Population-wide mortality trends among patients hospitalized for acute myocardial infarction: the Ontario experience, 1981 to 1991. J. Amer. Coll. Cardiol. 24 (1994), 1431–1438.Google Scholar
  20. 20.
    Pashos, C. L., J. P. Newhouse, B. J. McNeil: Temporal changes in the care and outcomes of elderly patients with acute myocardial infarction, 1987 through 1990. J. Amer. med. Ass. 270 (1993), 1832–1836.CrossRefGoogle Scholar
  21. 21.
    Pashos, C. L., S. L. T. Normand, J. B. Garfinkle, J. P. Newhouse, A. M. Epstein, B. J. McNeil: Trends in the use of drug therapies in patients with acute myocardial infarction: 1988 to 1992. J. Amer. Coll. Cardiol. 23 (1994), 1023–1030.CrossRefGoogle Scholar
  22. 22.
    Rasmussen, H. S., K. Meier, O. G. Larsen, J. Larsen: Hemodynamic effects of intravenous administered magnesium in patients with ischemic heart disease. Int. J. Cardiol. 11 (1988), 824–828.Google Scholar
  23. 23.
    Rasmussen, H. S., P. Aurup, K. Goldstein, P. Mc Nair, P. B. Mortensen, O. G. Larsen, H. Lawaetz: Influence of magnesium substitution therapy on blood lipid composition in patients with ischemic heart disease. Arch. intern. Med. 149 (1989), 1050–1053.PubMedCrossRefGoogle Scholar
  24. 24.
    Rogers, W. J., L. J. Bowlby, N. C. Chandra, W. J. French, J. M. Gore, C. T. Lambrew, M. Rubison, A. J. Tiefenbrunn, D. Weaver, for the participants in the National Registry of Myocardial Infarction: Treatment of myocardial infarction in the United States (1990 to 1993): observations from the National Registry of Myocardial Infarction. Circulation 90 (1994), 2103–2114.PubMedGoogle Scholar
  25. 25.
    Seelig, M. S.: Cardiovascular consequences of magnesium deficiency and loss: Pathogenesis, prevalence and manifestations — magnesium and chloride loss in refratory potassium repletion. Amer. J. Cardiol. 63 (1989), 4G-21G.PubMedCrossRefGoogle Scholar
  26. 26.
    Seelig, M. S.: Possible roles of magnesium in disorders of the aged. In: Regelson, W., F. M. Sinex (eds.): Intervention in the aging process. Part A: Quantitation, epidemiology, clinical research. A. R. Liss Inc, New York 1983, p. 279–305.Google Scholar
  27. 27.
    Shechter, M., E. Kaplinsky, B. Rabinowitz: The rationale of magnesium supplementation in acute myocardial infarction. A review of the literature. Arch. intern. Med. 152 (1992), 2189–2196.PubMedCrossRefGoogle Scholar
  28. 28.
    Shechter, M., H. Hod, N. Marks, S. Behar, E. Kaplinsky, B. Rabinowitz: Beneficial effect of magnesium sulfate in acute myocardial infarction. Amer. J. Cardiol. 66 (1990), 71–274.CrossRefGoogle Scholar
  29. 29.
    Teo, K. K., S. Yusuf, R. Collins, P. H. Held, R. Peto: Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomized trials. Brit. med. J. 303 (1991), 1499–1503.PubMedCrossRefGoogle Scholar
  30. 30.
    Tzivoni, D., A. Keren: Suppression of ventricular arrhythmias by magnesium. Amer. J. Cardiol. 65 (1990), 1397–1399.PubMedCrossRefGoogle Scholar
  31. 31.
    Woods, K. L.: Possible pharmacological actions of magnesium in acute myocardial infarction. Brit. J. clin. Pharmacol. 32 (1991), 3–10.Google Scholar

Copyright information

© Urban & Vogel 1997

Authors and Affiliations

  • M. Shechter
    • 1
    • 2
  • H. Hod
    • 1
  • P. Chouraqui
    • 1
  • E. Kaplinsky
    • 1
  • B. Rabinowitz
    • 1
  1. 1.Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of MedicineTel-Aviv UniversityIsrael
  2. 2.Preventive & Rehabilitative Cardiac CenterCedars-Sinai Medical CenterLos AngelesUSA

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