title: A randomized study of intravenous magnesium in acute myocardial infarction treated with direct coronary angioplasty.
abstract: BACKGROUND
  Notwithstanding the negative result of the International Study of Infarct Survival-4 (ISIS-4), the controversy about the role of magnesium in acute myocardial infarction is still open because, according to experimental data, magnesium could decrease myocardial damage and mortality only if infusion is started before reperfusion. This randomized placebo-controlled trial was designed to evaluate the effect of intravenous magnesium, delivered before, during, and after direct coronary angioplasty, in patients with acute myocardial infarction.
  
  
  METHODS
  One-hundred fifty patients were randomized to intravenous magnesium sulfate or placebo. The primary end point was an infarct zone wall motion score index at 30 days, as a measure of infarct size. The secondary end points included creatine kinase peak, ventricular fibrillation/tachycardia within the first 24 hours, death and congestive heart failure within the 30-day follow-up, and 30-day left ventricular ejection fraction. Analysis was by intention to treat.
  
  
  RESULTS
  There were no significant differences between the magnesium and placebo groups in the 30-day infarct zone wall motion score index (1.93 +/- 0.61 vs 1.85 +/- 0.51, P =.39), ventricular arrhythmias (24% vs 15%, P =.15), death (0 vs 1%, P =.32), heart failure (8% vs 7%, P =.75), and 30-day left ventricular ejection fraction (49% +/- 11% vs 50% +/- 9%, P = 0.55). There was a trend toward a higher creatine kinase peak in the magnesium group (3059 +/- 2359 vs 2404 +/- 1673,P =.052).
  
  
  CONCLUSIONS
  Intravenous magnesium delivered before, during, and after reperfusion did not decrease myocardial damage and did not improve the short-term clinical outcome in patients with acute myocardial infarction treated with direct angioplasty.
authors: Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
authors: G M
authors: GM
authors: Santoro
authors: D
authors: D
authors: Antoniucci
authors: L
authors: L
authors: Bolognese
authors: R
authors: R
authors: Valenti
authors: P
authors: P
authors: Buonamici
authors: M
authors: M
authors: Trapani
authors: A
authors: A
authors: Santini
authors: P F
authors: PF
authors: Fazzini
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D013318:Stroke Volume / Q000187:drug effects; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate