Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomised trials (original) (raw)

Abstract

OBJECTIVE--To investigate the effect of intravenous magnesium on mortality in suspected acute myocardial infarction. DESIGN--Systematic overview of all available randomised trials in which patients were allocated to receive either intravenous magnesium or otherwise similar treatment without magnesium. SETTING--Coronary care units of several hospitals. PATIENTS--1301 patients in seven randomised trials. MAIN OUTCOME MEASURE--Short term mortality. RESULTS--Considering the seven trials collectively there were 25 (3.8%) deaths among 657 patients allocated to receive magnesium and 53 (8.2%) deaths among 644 patients allocated control, generally during hospital follow up. This represents a 55% reduction in the odds of death (p less than 0.001) with 95% confidence intervals ranging from about one third to about two thirds. 70 of 648 patients allocated magnesium compared with 109 of 641 controls had serious ventricular arrhythmias, suggesting that magnesium reduces the incidence, though the definition varied among trials. Other adverse effects were rare in the limited number of patients for whom this data were available. CONCLUSION--Despite the limited number of patients randomised this overview suggests that intravenous magnesium therapy may reduce mortality in patients with acute myocardial infarction. Further large scale trials to confirm (or refute) these findings are desirable.

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Selected References

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  1. Abraham A. S., Rosenmann D., Kramer M., Balkin J., Zion M. M., Farbstien H., Eylath U. Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch Intern Med. 1987 Apr;147(4):753–755. [PubMed] [Google Scholar]
  2. Altura B. M., Altura B. T. Influence of magnesium on drug-induced contractions and ion content in rabbit aorta. Am J Physiol. 1971 Apr;220(4):938–944. doi: 10.1152/ajplegacy.1971.220.4.938. [DOI] [PubMed] [Google Scholar]
  3. Armstrong B. K. Oral contraceptives and breast cancer. Lancet. 1986 Mar 8;1(8480):552–553. doi: 10.1016/s0140-6736(86)90901-3. [DOI] [PubMed] [Google Scholar]
  4. Ceremuzyński L., Jurgiel R., Kulakowski P., Gebalska J. Threatening arrhythmias in acute myocardial infarction are prevented by intravenous magnesium sulfate. Am Heart J. 1989 Dec;118(6):1333–1334. doi: 10.1016/0002-8703(89)90027-6. [DOI] [PubMed] [Google Scholar]
  5. Chang C., Varghese P. J., Downey J., Bloom S. Magnesium deficiency and myocardial infarct size in the dog. J Am Coll Cardiol. 1985 Feb;5(2 Pt 1):280–289. doi: 10.1016/s0735-1097(85)80048-6. [DOI] [PubMed] [Google Scholar]
  6. Collins R., Gray R., Godwin J., Peto R. Avoidance of large biases and large random errors in the assessment of moderate treatment effects: the need for systematic overviews. Stat Med. 1987 Apr-May;6(3):245–254. doi: 10.1002/sim.4780060308. [DOI] [PubMed] [Google Scholar]
  7. Dyckner T. Serum magnesium in acute myocardial infarction. Relation to arrhythmias. Acta Med Scand. 1980;207(1-2):59–66. doi: 10.1111/j.0954-6820.1980.tb09676.x. [DOI] [PubMed] [Google Scholar]
  8. Dyckner T., Wester P. O. Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment. Am Heart J. 1979 Jan;97(1):12–18. doi: 10.1016/0002-8703(79)90108-x. [DOI] [PubMed] [Google Scholar]
  9. Elwood P. C., Sweetnam P. M., Beasley W. H., Jones D., France R. Magnesium and calcium in the myocardium: cause of death and area differences. Lancet. 1980 Oct 4;2(8197):720–722. doi: 10.1016/s0140-6736(80)91937-6. [DOI] [PubMed] [Google Scholar]
  10. Ghani M. F., Rabah M. Effect of magnesium chloride on electrical stability of the heart. Am Heart J. 1977 Nov;94(5):600–602. doi: 10.1016/s0002-8703(77)80129-4. [DOI] [PubMed] [Google Scholar]
  11. Hine L. K., Laird N. M., Hewitt P., Chalmers T. C. Meta-analysis of empirical long-term antiarrhythmic therapy after myocardial infarction. JAMA. 1989 Dec 1;262(21):3037–3040. [PubMed] [Google Scholar]
  12. Hine L. K., Laird N., Hewitt P., Chalmers T. C. Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Arch Intern Med. 1989 Dec;149(12):2694–2698. [PubMed] [Google Scholar]
  13. Hlatky M. A., Cotugno H. E., Mark D. B., O'Connor C., Califf R. M., Pryor D. B. Trends in physician management of uncomplicated acute myocardial infarction, 1970 to 1987. Am J Cardiol. 1988 Mar 1;61(8):515–518. doi: 10.1016/0002-9149(88)90756-4. [DOI] [PubMed] [Google Scholar]
  14. Leary W. P., Reyes A. J., Lockett C. J., Arbuckle D. D., van der Byl K. Magnesium and deaths ascribed to ischaemic heart disease in South Africa. A preliminary report. S Afr Med J. 1983 Nov 5;64(20):775–776. [PubMed] [Google Scholar]
  15. MISHRA R. K. Studies on experimental magnesium deficiency in the albino rat. 1. Functional and morphologic changes as sociated with low intake of Mg. Rev Can Biol. 1960 Jun;19:122–135. [PubMed] [Google Scholar]
  16. MacMahon S., Collins R., Peto R., Koster R. W., Yusuf S. Effects of prophylactic lidocaine in suspected acute myocardial infarction. An overview of results from the randomized, controlled trials. JAMA. 1988 Oct 7;260(13):1910–1916. [PubMed] [Google Scholar]
  17. Morton B. C., Nair R. C., Smith F. M., McKibbon T. G., Poznanski W. J. Magnesium therapy in acute myocardial infarction--a double-blind study. Magnesium. 1984;3(4-6):346–352. [PubMed] [Google Scholar]
  18. Perticone F., Adinolfi L., Bonaduce D. Efficacy of magnesium sulfate in the treatment of torsade de pointes. Am Heart J. 1986 Oct;112(4):847–849. doi: 10.1016/0002-8703(86)90486-2. [DOI] [PubMed] [Google Scholar]
  19. Peto R. Why do we need systematic overviews of randomized trials? Stat Med. 1987 Apr-May;6(3):233–244. doi: 10.1002/sim.4780060306. [DOI] [PubMed] [Google Scholar]
  20. Rasmussen H. S., Aurup P., Hojberg S., Jensen E. K., McNair P. Magnesium and acute myocardial infarction. Transient hypomagnesemia not induced by renal magnesium loss in patients with acute myocardial infarction. Arch Intern Med. 1986 May;146(5):872–874. doi: 10.1001/archinte.146.5.872. [DOI] [PubMed] [Google Scholar]
  21. Rasmussen H. S., Grønbaek M., Cintin C., Balsløv S., Nørregård P., McNair P. One-year death rate in 270 patients with suspected acute myocardial infarction, initially treated with intravenous magnesium or placebo. Clin Cardiol. 1988 Jun;11(6):377–381. doi: 10.1002/clc.4960110604. [DOI] [PubMed] [Google Scholar]
  22. Rasmussen H. S., McNair P., Norregard P., Backer V., Lindeneg O., Balslev S. Intravenous magnesium in acute myocardial infarction. Lancet. 1986 Feb 1;1(8475):234–236. doi: 10.1016/s0140-6736(86)90773-7. [DOI] [PubMed] [Google Scholar]
  23. Shechter M., Hod H., Marks N., Behar S., Kaplinsky E., Rabinowitz B. Beneficial effect of magnesium sulfate in acute myocardial infarction. Am J Cardiol. 1990 Aug 1;66(3):271–274. doi: 10.1016/0002-9149(90)90834-n. [DOI] [PubMed] [Google Scholar]
  24. Shine K. I. Myocardial effects of magnesium. Am J Physiol. 1979 Oct;237(4):H413–H423. doi: 10.1152/ajpheart.1979.237.4.H413. [DOI] [PubMed] [Google Scholar]
  25. Smith L. F., Heagerty A. M., Bing R. F., Barnett D. B. Intravenous infusion of magnesium sulphate after acute myocardial infarction: effects on arrhythmias and mortality. Int J Cardiol. 1986 Aug;12(2):175–183. doi: 10.1016/0167-5273(86)90239-1. [DOI] [PubMed] [Google Scholar]
  26. Turlapaty P. D., Altura B. M. Extracellular magnesium ions control calcium exchange and content of vascular smooth muscle. Eur J Pharmacol. 1978 Dec 1;52(3-4):421–423. doi: 10.1016/0014-2999(78)90303-5. [DOI] [PubMed] [Google Scholar]
  27. Turlapaty P. D., Altura B. M. Magnesium deficiency produces spasms of coronary arteries: relationship to etiology of sudden death ischemic heart disease. Science. 1980 Apr 11;208(4440):198–200. doi: 10.1126/science.7361117. [DOI] [PubMed] [Google Scholar]
  28. Woods K. L. Possible pharmacological actions of magnesium in acute myocardial infarction. Br J Clin Pharmacol. 1991 Jul;32(1):3–10. doi: 10.1111/j.1365-2125.1991.tb05605.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Yusuf S., Peto R., Lewis J., Collins R., Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985 Mar-Apr;27(5):335–371. doi: 10.1016/s0033-0620(85)80003-7. [DOI] [PubMed] [Google Scholar]