Effect of magnesium on restenosis after percutaneous transluminal coronary angioplasty: a clinical and angiographic evaluation in a randomized patient population

Abstract

Restenosis is a major clinical problem following successful percutaneous transluminal coronary angioplasty. Since magnesium has vasodilator and antithrombotic effects, this study was designed to evaluate its potential to decrease the rate of restenosis. In an open-labelled, randomized controlled study, 148 patients underwent successful coronary angioplasty. Ninety-eight patients were treated with 46-52 mmol/18-20 h intravenous magnesium sulphate (groups M1 and M2), and 49 of them continued with oral supplements of magnesium hydroxide 600 mg.day-1 (group M2). The other 50 patients served as controls (group C). Coronary angiography was performed before, immediately after and at 6 months follow-up or earlier if clinically indicated. Clinical, laboratory, ergometric and radionuclide evaluations were also carried out. One hundred and thirty-nine patients (94%) with 163 dilated segments completed the study. Intravenous magnesium was well tolerated. The cross-sectional area at the site of angioplasty increased by 3.55 +/- 2.01 mm2 in groups M1 and M2 compared with an increase of 2.90 +/- 1.63 mm2 in the control group, (P = 0.03). A trend towards a lower rate of restenosis (> 50% reduction in luminal diameter) was noticed in the magnesium groups (28/110, 25%) compared with the control group (20/53, 38%) P = 0.10. Oral administration of magnesium was well tolerated, did not have an additive effect on restenosis, but an improved clinical course was noted. It is concluded that intravenous administration of magnesium in patients undergoing coronary angioplasty is feasible and safe and that the beneficial trend of magnesium to prevent acute recoil and late (within 6 months) restenosis is encouraging and should promote further investigation in a larger patient population.

Exogeneous metal ions as therapeutic agents in cardiovascular disease and their delivery strategies

“…The efficacy of magnesium sulfate in reducing early mortality after MI might be attributed to the beneficial cardiovascular effects of Mg 2+ at pharmacological concentrations [ 196 ]. In addition, clinical studies have also found a beneficial trend of Mg 2+ in reducing the rate of restenosis after percutaneous coronary angioplasty [ 197 ].…”

Temporal changes in circulating P-selectin, plasminogen activator inhibitor-1, magnesium, and creatine kinase after percutaneous coronary intervention

“…PAI-1 was measured by a luminescence substrate method. Another 3 ml blood was placed in a centrifuge tube without anticoagulants and serum was obtained by centrifugation for the evaluation of full blood chemistry (Beckman Synchron CX3, Beckman Instruments Inc., Brea, CA, USA) including Mg levels (atomic absorption spectrophotometry; Perkin-Elmer 3100, Norwalk, CN, USA) (Roth et al, 1994). Subjects were routinely discharged 3-5 d after CAG.…”

<b>Irradiation and Postangioplasty Restenosis</b>

“…Restenosis is also decreased in 'ideal' lesions and non-diabetic patients, mostly by achieving a bigger post-procedural lumen diameter and preventing early elastic recoil and late arterial remodeling. 4,5,[32][33][34] Antiplatelet therapy with aspirin and ticlopidine or clopidogrel decreases the complications of subacute stent thrombosis and access site bleeding induced by warfarin, so coronary stenting is now being used in an ever-increasing variety of clinical settings and complex lesions. However, despite their proven benefits, coronary stents continue to have several limitations.…”