Is there a place for magnesium in the treatment of acute myocardial infarction?

• Published in: The American heart journal 1996-08, Vol.132 (2), p.471-477
• Main Authors: Seelig, Mildred S., Elin, Ronald J.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Calcium Channel Blockers - therapeutic use; Cardiovascular system; Clinical Trials as Topic; Humans; Infusions, Intravenous; Magnesium Sulfate - therapeutic use; Medical sciences; Miscellaneous; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Reperfusion; Pharmacology. Drug treatments; Thrombolytic Therapy; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(96)90338-5

Infusions of solutions of magnesium sulfate for patients with acute myocardial infarction were shown by a meta-analysis of seven small studies and a larger study of 2316 patients (LIMIT-2) to have clinical efficacy. However, the ISIS-4 study of 58,050 patients found no improvement in short-term mortality rates with magnesium therapy in patients with acute myocardial infarction. In this article we explore the following four differences between the ISIS-4 study and the earlier studies: (1) Time of initiation of magnesium treatment after acute myocardial infarction and thrombolytic therapy; (2) dosage of magnesium in the first 24 hours after acute myocardial infarction; (3) duration of magnesium infusion after acute myocardial infarction; and (4) differences in patient risks in control and treatment groups. These four differences may explain the different outcomes among these studies and indicate the type of additional studies that are needed to define the clinical utility of magnesium infusion in the treatment of patients with acute myocardial infarction.