Review of clinical evidence - Is there a role for supplemental magnesium in acute myocardial infarction in high-risk populations (patients ineligible for thrombolysis and the elderly)?

Coronary Artery Disease

Volumn 7, Issue 5, 1996, Pages 352-358

  Shechter, Michael ^a   Kaplinsky, Elieser ^b   Rabinowitz, Babeth ^b  

^a CEDARS SINAI MEDICAL CENTER   (United States)

^b NONE

Author keywords

clinical trials; coronary artery disease; magnesium; myocardial infarction

Indexed keywords

MAGNESIUM;

ANTICOAGULATION; BLOOD CLOT LYSIS; BLOOD VESSEL TONE; DIET SUPPLEMENTATION; HEART ARRHYTHMIA; HEART INFARCTION; HEART INFARCTION SIZE; HUMAN; POPULATION RISK; PRIORITY JOURNAL; REVIEW;

EID: 0029787515     PISSN: 09546928     EISSN: None     Source Type: Journal    
DOI: 10.1097/00019501-199605000-00004     Document Type: Review

References (80)

1. The GUSTO Investigators: GUSTO: an international trial comparing thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993, 329:673-682.
2. Althouse R, Maynard C, Cerguiera MD, Olsufka M, Ritchie JL, Kennedy JW: The Western Washington Myocardial Infarction Registry and Emergency Department Tissue Plasminogen Activator Treatment Trial. Am J Cardiol 1990, 66:1298-1303.
3. Behar S, Abinader E, Caspi A, David D, Flich M, Friedman Y, et al.: Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel. Am J Cardiol 1991, 68:1291-1294.
4. Behar S, Gilat D, Reicher-Reiss H, Kaplinsky E, Zion M, Mandelzweig L, et al.: Myocardial infarction in patients older than 75 years of age: the short- and long-term prognosis in 653 consecutive patients. Cardiol Elderly 1993, 1:103-111. In-hospital mortality in elderly AMI patients in Israel before the thrombolytic era.
5. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, et al.: Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. Circulation 1995, 91:1659-1668. A comprehensive analysis of relations between clinical data and 30-day mortality and a multivariable statistical model for risk assessment in candidates for thrombolytic therapy in AMI.
6. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group: Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994, 343:311-322.
7. Montague TJ, Ikuta RM, Wong RY, Bay KS, Teo KK, Davis NJ: Comparison of risk and pattern of practice in patients older and younger than 70 years with acute myocardial infarction in a two-year period (1987-1989). Am J Cardiol 1991, 68:843-847.
8. Maggioni AP, Maseri A, Fresco C, Franzosi M, Mauri F, Santoro E, et al.: Age-related increase in mortality among patients with first myocardial infarction treated with thrombolysis. N Engl J Med 1993, 329:1442-1448.
9. Kirklin JW, Akins CW, Blackstone EH, Booth DC, Califf RM, Cohen LS, et al.: ACC/AHA guidelines and indications for coronary artery bypass graft surgery. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. Circulation 1991, 83:1125-1172.
10. Weaver WD, Litwin PE, Martin JS, Kudenchuck PJ, Maynard C, Eisenberg MS, et al.: Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. J Am Coll Cardiol 1991, 18:657-662.
11. Ball S, Corrao J, Gore J, Goldberg R: Patients ineligible for thrombolytic therapy: the GUSTO acute myocardial infarction census log [abstract]. Circulation 1993, 88:160.
12. Seelig MS: Cardiovascular consequences of magnesium deficiency and loss: Pathogenesis, prevalence and manifestations - magnesium and chloride loss in refractory potassium repletion. Am J Cardiol 1989, 63:4G-21G. An excellent review of magnesium metabolism in the elderly.
13. Seelig MS: Possible roles of magnesium in disorders of the aged. In Intervention in the Aging Process, Part A: Quantitation, Epidemiology, Clinical Research. Edited by Regelson W, Sinex FM. New York: AR Liss Inc: 1983:279-305.
14. Johansson G: Magnesium metabolism: studies in health, primary hyperparathyroidism and renal stone disease. Scand J Urol Nephrol 1979, 51:1-47.
15. Shechter M, Kaplinsky E, Rabinowitz B: The rationale of magnesium supplementation in acute myocardial infarction. A review of the literature. Arch Intern Med 1992, 152:2189-2196. A review that summarizes the physiologic and pharmacologic effects of the magnesium ion and discuss the rationale for treating patients with AMI with magnesium infusion.
16. Dickens BF, Weglicki WB, Li YS, Mak IT: Magnesium deficiency in vitro enhances free radical-induced intracellular oxidation and cytotoxicity in endothelial cells. FEBS Lett 1992, 311:187-191.
17. Iseri LT, French JM: Magnesium: nature's physiologic calcium blocker. Am Heart J 1984, 108:188-193.
18. Holyrode MI, Robertson SP, Johnson JD, Solaro RI, Potter JD: The calcium and magnesium binding sites on cardiac troponin and their role in the regulation of myofibrillar adenosine triphosphatase. J Biol Chem 1980, 255:11688-11691.
19. Sordahl LA: Effects of magnesium on initial rates of calcium uptake and release of heart mitochondria. Arch Biochem Biophys 1975, 167:104-107.
20. Mroczek WJ, Lee WR, Davidov ME: Effect of magnesium sulfate on cardiovascular hemodynamics. Angiology 1977, 28:720-724.
21. Cotton DB, Gonik B, Dorman KF: Cardiovascular alterations in severe pregnancy-induced hypertension: acute effects of intravenous magnesium sulfate. Am J Obstet Gynecol 1984, 148:162-165.
22. Rasmussen HS, Meier K, Larsen OG, Larsen J: Hemodynamic effects of intravenous administered magnesium in patients with ischemic heart disease. Int J Cardiol 1988, 11:824-828.
23. Altura BM, Altura BT: New perspectives on the role of magnesium in the pathophysiology of the cardiovascular system. Magnesium 1985, 4:245-271.
24. Altura BM: Magnesium neurohypophyseal hormone interactions in contraction of vascular smooth muscle. Am J Physiol 1975, 228:1615-1620.
25. Altura BM, Altura BT, Corella A: Magnesium deficiency-induced spasms of umbilical vessels: relation to preeclampsia, hypertension, growth retardation. Science 1983, 221:376-378.
26. Altura BM, Altura BT: Vascular smooth muscle and prostaglandins. Fed Proc 1976, 35:2360-2366.
27. Askar AD, Mustafa SJ: Role of magnesium in the relaxation of coronary arteries by adenosine. Magnesium 1983, 2:17-25.
28. Whelton PK, Klay MJ: Magnesium and blood pressure: review of the epidemiologic and clinical trial experience. Am J Cardiol 1989, 63:26G-30G.
29. Kugiyama K, Yasue H, Okumara K, Goto K, Minoda K, Miyagi H, et al.: Suppression of exercise-induced angina by magnesium sulfate in patients with variant angina. J Am Coll Cardiol 1988, 12:1177-1183.
30. Altura BM, Altura BT: Magnesium ions and contraction of vascular smooth muscles: relationship to some vascular diseases. Fed Proc 1981, 40:2672-2674.
31. Lucas MJ, Veveno KJ, Cunningham FG: A comparison of magnesium sulfate with phenytoin for prevention of eclampsia. N Engl J Med 1995, 333:201-205.
32. Zwillinger L: Uber die Magnesiumwirkung auf das Herz. Klin Wochenschr 1935, 14:1329-1433.
33. Chadda KD, Liebstein E, Gapta P: Hypomagnesemia and refractory cardiac arrhythmia in a nondigitalized patient. Am J Cardiol 1973, 31:98-100.
34. Beller GA, Hood WB Jr, Abelmann WH, Weacker WEC: Correlation of serum magnesium levels and cardiac digitalis intoxication. Am J Cardiol 1974, 33:225-229.
35. Tzivoni D, Keren A: Suppression of ventricular arrhythmias by magnesium. Am J Cardiol 1990, 65:1397-1399. An excellent review of the antiarrhythmic effects of magnesium.
36. Tzivoni D, Keren A, Cohen AM, Loebel H, Zahavi I, Chenzbraun A, et al.: Magnesium therapy for torsade de pointes. Am J Cardiol 1984, 53:528-530.
37. Lloyd T, Iseri MD, Fairshter R, Hardemann JL, Brodsky MA: Magnesium suppression of exercise-induced angina by magnesium sulfate in patients with variant angina. J Am Coll Cardiol 1988, 12:1177-1183.
38. Whang R, Welt LC: Observations in experimental magnesium depletion. Clin Invest 1963, 42:305-313.
39. Lloyd T, Iseri MD, Fairshter R, Hardemann JL, Brodsky MA: Magnesium and potassium therapy in multifocal atrial tachycardia. Am Heart J 1985, 110:789-794.
40. Arsenian MA: Magnesium and cardiovascular disease. Prog Cardiovasc Dis 1993, 35:271-310.
41. Cummins RO: Ventricular fibrillation/pulseless ventricular tachycardia algorithm. In Textbook of Advanced Cardiac Life Support. Edited by Cummins RO. Dallas: American Heart Association; 1994:1-15-1-20.
42. Ouchi Y, Tabata RE, Stergiopoulos K, Sato F, Hattori A, Orimo H: Effect of dietary magnesium on development of atherosclerosis in cholesterol fed rabbits. Arteriosclerosis 1990, 10:732-737.
43. Rayssiguier Y, Guex E, Weiser D: Effect of magnesium deficiency on lipid metabolism in rats fed a high carbohydrate diet. J Nutr 1981, 111:1876-1883.
44. Luthringer C, Rayssiguier Y, Gueux E, Berthelo A: Effect of moderate magnesium deficiency on serum lipids, blood pressure and cardiovascular reactive in normotensive rats. Br J Nutr 1988, 59:243-250.
45. Rasmussen HS, Aurup P, Goldstein K, McNair P, Mortensen PB, Larsen OG, et al.: Influence of magnesium substitution therapy on blood lipid composition in patients with ischemic heart disease. Arch Intern Med 1989, 149:1050-1053. The first report on the beneficial effect of oral magnesium supplementation on lipids in humans.
46. Davis WH, Leary WP, Reyes AH: Monotherapy with magnesium increases abnormally low high density lipoprotein cholesterol: a clinical assay. Curr Ther Res 1984, 36:341-344.
47. Greville GD, Lehmann H: Cation antagonism in blood coagulation. J Physiol 1943, 103:175-184.
48. Schnitzler B: Thromboseprophylaxe mit Magnesium. Münch Med Wochenschr 1957, 99:81-84.
49. Anstall HB, Huntsman RG, Lehmann H, Hayward GH, Wetzman D: The effect of magnesium on blood coagulation in human subjects. Lancet 1959, 1:814-815.
50. Adams JH, Mitchel JRA: The effect of agents which modify platelet behavior and of magnesium ions on thrombus formation in vivo. Thromb Haemostasis 1979, 42:603-610.
51. Frandsen NJ, Winther K, Pedersen F, Christiansen I, McNair P: Magnesium and platelet function: in vivo influence on aggregation and alpha-granule release in healthy volunteers. Magnesium Bull 1995, 17:37-40.
52. Hwang DL, Yen CF, Nadler JL: Effect of extracellular magnesium on platelet activation and intracellular calcium mobilization. Am J Hypertens 1992, 5:700-706.
53. Born GVR, Cross GP: Effect of inorganic ions and plasma proteins on the aggregation of blood platelets by adenosine diphosphate. J Physiol 1964, 170:397-414.
54. Gawaz M, Ott I, Reininger AJ, Neumann FJ: Effects of magnesium on platelet aggregation and adhesion. Magnesium modulates surface expression of glycoproteins on platelets in vitro and ex vivo. Thromb Haemostasis 1994, 72:912-918. It is demonstrated that pharmacologic concentrations of magnesium effectively inhibit platelet function in vitro and ex vivo.
55. Nadler JL, Goodson S, Rude RK: Evidence that prostacyclin mediates the vascular action of magnesium in humans. Hypertension 1987, 9:379-383.
56. Ferrari R, Albertini A, Curellos S, Ceconi C, Di Lisa F, Raddino R, et al.: Myocardial recovery during post-ischemic reperfusion: effects of nifedipine, calcium, and magnesium. J Moll Cell Cardiol 1986, 18:487-498.
57. Vormann J, Fiscer G, Classen HG, Thoni H: Influence of decreased and increased magnesium supply on cardiotoxic effects of epinephrine in rats. Arzneimittelforschung 1983, 33:205-210.
58. Horner SM: Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Meta-analysis of magnesium in acute myocardial infarction. Circulation 1992, 86:774-779. An excellent overview of the antiarrhythmic effect of magnesium in randomized clinical trials in patients with AMI.
59. Banai S, Haggroth L, Epstein SE, Casscells W: Influence of extracellular magnesium on capillary endothelial cell proliferation and migration. Circ Res 1990, 67:645-650.
60. Barros LFM, Chagas ACP, da Luz PL, Pileggi F: Magnesium treatment of acute myocardial infarction: effects on necrosis in an occlusion/reperfusion dog model. Intern J Cardiol 1995, 48:3-9.
61. Morton BC, Nair RC, Smith FM, McKibbon TG, Poznansky WJ: Magnesium therapy in acute myocardial infarction. Magnesium 1984, 3:346-352. The first clinical trial of intravenous magnesium supplementation in AMI patients and the assumption that magnesium can reduce the infarct size.
62. Rasmussen HS, McNair P, Norregard P, Backer V, Lindeneg O, Balslov S: Magnesium infusion in acute myocardial infarction. Lancet 1986, i:234-236.
63. Rasmussen HS, Gronbaek M, Cintin C, Balslov S, Norregard P, McNair P: One-year rate in 270 patients with suspected acute myocardial infarction, initially treated with intravenous magnesium or placebo. Clin Cardiol 1988, 11:377-381. The first report on long-term follow-up of intravenous magnesium supplementation in AMI patients.
64. Smith LF, Heagerty AM, Bing RF, Barnett DB: Intravenous infusion of magnesium sulphate after acute myocardial infarction: effects on arrhythmias and mortality. Int J Cardiol 1986, 12:175-180.
65. Abraham AS, Rosenman D, Meshulam Z, Zion M, Eylath U: Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch Intern Med 1987, 147:753-755.
66. Ceremuzynski L, Jurgiel R, Kulakowski P, Gebalska J: Threatening arrhythmias in acute myocardial infarction are prevented by intravenous magnesium sulfate. Am Heart J 1989, 118:1333-1334.
67. Shechter M, Hod H, Marks N, Behar S, Kaplinsky E, Rabinowitz B: Beneficial effect of magnesium sulfate in acute myocardial infarction. Am J Cardiol 1990, 66:271-274.
68. Shechter M, Hod H: Magnesium therapy in aged patients with acute myocardial infarction. Magnesium Bull 1991, 13:7-9.
69. Feldstedt M, Boesgaard S, Bouchelouche P, Svenningsen A, Brooks L, Lech Y, et al.: Magnesium substitution in acute ischaemic heart syndromes. Eur Heart J 1991, 12:1215-1218.
70. Woods KL, Fletcher S, Roffe C, Haider Y: Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2) Lancet 1992, 339:1553-1558. The largest clinical trial to demonstrate that magnesium can reduce mortality by 24% and conjestive heart failiure by 25% at 28 days after AMI.
71. Teo KK, Yusuf S, Collins R, Held PH, Peto R: Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomized trials. BMJ 1991, 303:1499-1503. Meta-analysis of randomized clinical trials of magnesium in AMI, which strongly demonstrates the beneficial effect of magnesium in reducing mortality.
72. Woods KL, Fletcher S: Long term outcome after intravenous magnesium sulphate in suspected acute myocardial infarction: the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1994, 343:816-819.
73. Shechter M, Hod H, Chouraqui P, Kaplinsky E, Rabinowitz B: Magnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy. Am J Cardiol 1995, 75:321-323. First report of the beneficial effect of magnesium in reducing in-hospital mortality in AMI patients who are at high risk of mortality and morbidity (i.e. patients ineligible for thrombolysis and the elderly).
74. ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction. Lancet 1995, 345:669-685 The largest mega-trial of intravenous magnesium supplementation in patients with suspected or definite AMI to suggest no mortality benefit of magnesium, and even a slight possibility of harm.
75. du Toit EF, Opie LH: Modulation of severity of reperfusion stunning in the isolated heart by agents altering calcium flux at reperfusion. Circ Res 1992, 70:960-967.
76. Leor J, Kloner RA: An experimental model examining the role of magnesium in the therapy of acute myocardial infarction. Am J Cardiol 1995, 75:1292-1293.
77. Atar D, Serebruany V, Poulton J, Godard J, Schneider A, Herzog WR: Effects of magnesium supplementation in a porcine model of myocardial ischemia and reperfusion. J Cardiovasc Pharmacol 1994, 24:603-611. Acute intravenous magnesium supplementation protects against myocardial stunning in an in-situ swine model of regional ischemia and reperfusion in addition to inhibiting platelet aggregation.
78. Herzog WR, Atar D, Mak IT, Alyono D, MacCord C, Weglicki WB: Magnesium deficiency prolongs myocardial stunning in an open-chest swine model. Int J Cardiol 1995, 47:105-115. Magnesium deficiency is associated with prolonged recovery from myocardial stunning in an open-chest swine model.
79. Seelig MS, Elin RJ: Reexamination of magnesium infusions in myocardial infarction. Am J Cardiol 1995, 76:172-173. The authors try to settle the controversy between the negative findings of ISIS-4 and the positive findings in LIMIT-2 and the small controlled studies.
80. Antman EM: Randomized trials of magnesium in acute myocardial infarction: big numbers do not tell the whole story. Am J Cardiol 1995, 75:391-393. In this editorial to the study by Woods et al. [70] the author analyzes the results of ISIS-4 and explains the discrepancies between ISIS-4 and previous clinical trials. The author emphasizes the importance of the early administration of magnesium infusion in AMI patients.