Magnesium

Magnesium produces systemic and coronary vasodilatation, possesses antiplatelet activity, suppresses automaticity, and protects myocytes from calcium influx during reperfusion. One meta-analysis of seven randomized trials found a significant mortality-rate benefit in patients with AMI. 41 In the 2316 patients in the Leicaster Intravenous Magnesium Intervention Trial (LIMIT-2), magnesium-treated patients had a 21 to 25 percent reduction in short-term mortality rate and the incidence of congestive heart failure and 4-year cardiovascular mortality rate was also reduced. 42 Studies, however, are conflicting: some have found mortality rate reduced by about 75 percent, whereas others have showed no benefit at all. The disparity in findings may be related to the interval between symptom onset and magnesium administration, and various concurrent therapies (including fibrinolysis). In light of these conflicting data, the ACC/AHA guidelines support correction of documented hypomagnesemia during AMI and treatment of torsades-type ventricular tachycardia with a prolonged QT interval. 4 Magnesium bolus and infusion in high-risk patients, such as the elderly and those in whom reperfusion therapy is not suitable, is considered possibly beneficial. 4

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