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Acute myocardial infarction without thrombolytic therapy: beneficial effects of magnesium sulfate
M Shechter1, H Hod, P Chouraqui
1Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Intravenous magnesium sulfate may reduce complications and mortality in acute myocardial infarction (AMI) patients not receiving thrombolytic therapy. This benefit was observed in elderly patients, suggesting magnesium as a potential treatment for high-risk individuals.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) affects many hospitalized patients.
- Thrombolytic therapy, beneficial for AMI outcomes, is underutilized, especially in elderly patients.
- Elderly patients face higher mortality risks during AMI.
Purpose of the Study:
- To evaluate the impact of magnesium supplementation on AMI patients who did not receive thrombolytic therapy.
- To assess magnesium's effect on complications and mortality in high-risk AMI subgroups, including the elderly.
Main Methods:
- A prospective, randomized, placebo-controlled study involving 194 AMI patients.
- Participants received either a 48-hour intravenous magnesium sulfate infusion (96 patients) or isotonic glucose placebo (98 patients).
- Outcomes including arrhythmias, congestive heart failure, and in-hospital mortality were compared between groups.
Main Results:
- Magnesium infusion significantly reduced in-hospital mortality (4% vs. 17%, p < 0.01) compared to placebo.
- Magnesium also decreased the incidence of arrhythmias (27% vs. 40%, p = 0.04) but not significantly congestive heart failure (18% vs. 23%, p = 0.27).
- In elderly patients (>70 years), magnesium showed a positive trend in reducing mortality (9% vs. 23%) and arrhythmias (42% vs. 50%).
Conclusions:
- Intravenous magnesium supplementation may be beneficial in reducing myocardial damage and mortality in high-risk AMI patients, particularly the elderly or those unsuitable for thrombolysis.
- Further trials are warranted to confirm magnesium's benefits in specific AMI patient subsets.
- Magnesium's role in managing AMI warrants further investigation, especially for patients ineligible for standard reperfusion therapies.
Abstract:
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.