The Importance of Magnesium Values in Patients With STEMI Admitted to the Emergency Department
Melih Yuksel1, Turgay Isik2, Ibrahim Halil Tanboga3
11 Department of Emergency Medicine, School of Medicine, Balikesir University, Balikesir, Turkey.
Insights
Initial low magnesium levels predict poor outcomes after ST-segment elevation myocardial infarction (STEMI) treatment. Low serum magnesium is an independent predictor of no-reflow and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment.
- Primary percutaneous coronary intervention (pPCI) is the standard reperfusion therapy for STEMI.
- No-reflow phenomenon, a complication of pPCI, is associated with adverse outcomes.
Purpose of the Study:
- To investigate the association between initial serum magnesium (Mg) levels and electrocardiographic no-reflow.
- To determine if initial Mg levels predict long-term mortality in STEMI patients treated with pPCI.
- To explore the role of Mg in the context of other biomarkers like high-sensitive C-reactive protein (hs-CRP).
Main Methods:
- A cohort of 111 patients undergoing pPCI for STEMI was studied.
- Serum Mg and hs-CRP levels were measured upon admission.
- Electrocardiographic signs of no-reflow were assessed using the sum of ST-segment resolution (∑STR) 60 minutes post-intervention.
- Patients were followed for major adverse cardiac events for up to 51 months.
Main Results:
- The study identified a threshold of Mg ≤1.87 mg/dL with 77% sensitivity and 59% specificity for predicting no-reflow.
- Multivariate analysis revealed Mg, hs-CRP, left anterior descending artery lesion, and reperfusion time as independent predictors of electrocardiographic no-reflow.
- Serum Mg level emerged as the sole independent predictor of long-term mortality (OR: 0.08, P = .05).
Conclusions:
- Initial serum magnesium levels are a significant independent predictor of electrocardiographic no-reflow following pPCI in STEMI patients.
- Low serum magnesium is also an independent predictor of long-term mortality in this patient population.
- These findings highlight the potential role of magnesium as a prognostic biomarker in STEMI management.
Aim:
The aim of this study is to examine the relationship between initial magnesium (Mg) levels, electrocardiographic no-reflow, and long-term mortality in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI).
Methods:
A total of 111 patients with pPCI participated in the study. Magnesium and high-sensitive C-reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was measured immediately before and 60 minutes after the restoration of coronary flow. The difference between the 2 measurements was taken as the amount of ST-segment resolution and defined as sum of ST-segment resolution (∑STR). The ∑STR <50% was determined as electrocardiographic sign of no-reflow phenomenon. After the patients were discharged, they were followed up for major adverse cardiac events for up to 51 months after discharge.
Results:
Forty patients in the no-reflow group and 71 patients in the normal-flow group were included in the study. Magnesium value ≤1.87 mg/dL initially measured had 77% sensitivity and 59% specificity in predicting no-reflow on receiver operating characteristic curve analysis. In multivariate analyses, Mg (odds ratio [OR]: 0.01, <95% confidence interval [CI]: 0.01-0.12; P = .004), hs-CRP (OR: 1.06, <95% CI: 1.00-1.14; P = .05), left anterior descending artery lesion (OR: 6.66, <95% CI: 1.45-3.05; P = .01), and reperfusion time (OR: 1.01, <95% CI: 1.00-1.01; P = .03) were still independent predictors of electrocardiographic no-reflow, and only Mg (OR: 0.08, <95% CI: 0.01-1.03; P = .05) was still an independent predictor of long-term mortality.
Conclusion:
Serum Mg level is an independent predictor of electrocardiographic no-reflow and long-term mortality in patients with STEMI.
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