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

Akuter Myokardinfarkt ohne thrombolytische Therapie: Vorteilhafte Wirkungen von Magnesiumsulfat

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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.

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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Authors and Affiliations

  1. Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel-Aviv University, Israel

    M. Shechter MD, MA, H. Hod, P. Chouraqui, E. Kaplinsky & B. Rabinowitz

  2. Preventive & Rehabilitative Cardiac Center, Cedars-Sinai Medical Center, Mark Goodson Building, Suite # 901, 444 South San Vicente Boulevard, 90048, Los Angeles, CA, USA

    M. Shechter MD, MA

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Shechter, M., Hod, H., Chouraqui, P. et al. Acute myocardial infarction without thrombolytic therapy: Beneficial effects of magnesium sulfate. Herz 22 (Suppl 1), 73–76 (1997). https://doi.org/10.1007/BF03042658

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