title: Digoxin and short term mortality after acute STEMI: Results from the MAGIC trial.
abstract: BACKGROUND
  The safety of digoxin has been a subject of debate for decades, most recently among patients with atrial fibrillation (AF). Digoxin has been used during the acute phase of ST elevation myocardial infarction (STEMI) complicated with AF or heart failure. Data about digoxin in this setting are scarce.
  
  
  OBJECTIVE
  We hypothesize that digoxin maybe associated with increased mortality when used during the acute phase of ST segment myocardial infarction.
  
  
  METHODS
  We investigated the association between digoxin and mortality in patients enrolled in the MAGnesium In Coronaries (MAGIC) study, which evaluated the efficacy of early magnesium administration in STEMI. Multiple Cox proportional hazards models were examined to assess the aforementioned association after correction for clinical characteristics and comorbidities.
  
  
  RESULTS
  After excluding 639 (10.3%) patients for missing data, we analyzed the remaining 5574 patients. There were 852 (15.3%) deaths during the one month follow-up and 170 (3.0%) patients on digoxin concomitantly, among which 42 patients (24.7%) died. There was a statistically significant association between digoxin and increased mortality in the unadjusted statistical analysis; however, this association disappeared after correction for clinical characteristics and comorbidities in the primary multivariable analysis (estimated hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.62-1.19, p=0.372) and in three additional multivariable analyses.
  
  
  CONCLUSIONS
  Digoxin use as a new or preexisting medication during the acute phase of STEMI in the MAGIC trial was not associated with a significant increase in mortality after correcting for clinical characteristics and comorbidities.
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States. Electronic address: mohamed.metawee@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Metawee
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Charnigo
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Morales
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Darrat
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sorrell
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Delisle
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
authors.affiliation: University of Kentucky, Gill Heart Institute, Lexington, KY, United States; VAMC, Cardiology, Lexington, KY, United States.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004077:Digoxin / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*
chemical_list: D004077:Digoxin; D008278:Magnesium Sulfate
keywords: Digoxin; Mortality; Myocardial infarction