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Magnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy
M Shechter1, H Hod, P Chouraqui
1Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Magnesium sulfate significantly reduced in-hospital mortality and complications in acute myocardial infarction (AMI) patients ineligible for thrombolytic therapy, offering a promising alternative treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Thrombolytic therapy improves survival in acute myocardial infarction (AMI) but is not administered to most patients.
- A significant portion of AMI patients experience high in-hospital mortality due to lack of thrombolysis.
- Prior trials suggest magnesium sulfate may decrease in-hospital mortality.
Purpose of the Study:
- To investigate the efficacy of magnesium sulfate in AMI patients unsuitable for thrombolytic therapy.
- To assess magnesium sulfate's impact on mortality, arrhythmias, heart failure, and cardiac function.
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 194 AMI patients ineligible for thrombolysis.
- Patients received either 48-hour intravenous magnesium sulfate or a glucose placebo.
- Outcomes including arrhythmias, heart failure, ejection fraction, and mortality were monitored.
Main Results:
- Magnesium sulfate reduced arrhythmias (27% vs 40%, p=0.04) and improved left ventricular ejection fraction (49% vs 43% at 72h, p=0.01).
- In-hospital mortality was significantly lower in the magnesium group (4% vs 17%, p<0.01).
- Benefits were also observed in elderly patients (>70 years), with reduced mortality (9% vs 23%, p=0.09).
Conclusions:
- Magnesium sulfate demonstrates significant benefits for AMI patients ineligible for thrombolytic therapy.
- It reduces complications, improves cardiac function, and lowers in-hospital mortality.
- Magnesium sulfate should be considered a viable alternative treatment option in this patient population.
Abstract:
Thrombolytic therapy reduces in-hospital mortality. However, 70% to 80% of patients do not receive thrombolysis and their in-hospital mortality is high. During the last decade some clinical trials demonstrated that magnesium sulfate reduced in-hospital mortality. The aim of this study was to evaluate the effects of magnesium sulfate in patients with acute myocardial infarction (AMI) who were considered unsuitable for thrombolytic therapy. Intravenous magnesium sulfate was evaluated in 194 patients with AMI ineligible for thrombolytic therapy in a randomized, double-blind, placebo-controlled study. Group I consisted of 96 patients who received 48-hour intravenous magnesium. Group II consisted of 98 patients who received isotonic glucose as a placebo. Magnesium reduced the incidence of arrhythmias, congestive heart failure, and conduction disturbances compared with placebo (27% vs 40%, p = 0.04; 18% vs 23%, p = 0.27; 10% vs 15%, p = 0.21, respectively). Left ventricular ejection fraction 72 hours and 1 to 2 months after admission was higher in patients who received magnesium sulfate than in those taking placebo (49% vs 43% and 52% vs 45%; p = 0.01, respectively). In-hospital mortality was significantly reduced in patients receiving magnesium sulfate than in those receiving placebo (4% vs 17%; p < 0.01), and also in the subgroup of elderly patients (> 70 years) (9% vs 23%; p = 0.09). In conclusion, magnesium sulfate should be considered as an alternative therapy to thrombolysis in patients with AMI.