Low magnesium is not a significant predictor of hard events in acute myocardial infarction

Abstract

BackgroundAlthough magnesium (Mg) has recognized cardioprotective properties and hypomagnesemia is common in patients with acute myocardial infarction (AMI), data regarding the role of Mg as prognostic factor for adverse events are scarce, as well as there are conflicting results on the use of Mg as adjuvant therapy in AMI.AimTo evaluate the role of Mg as predictor for hard events (HE, all cause death, and nonfatal myocardial infarction) in AMI patients.Design and patientsWe studied 406 AMI patients (306 males, age: 67 ± 12 years, mean ± SD). Patient data were collected from the Institute electronic databank which saves demographic, clinical, instrumental, therapeutical and follow-up data of all patients admitted to our Coronary Unit.ResultsDuring a mean follow-up period of 21 ± 18 months, the combined endpoint accounted for 63 HE, 44 (11%) deaths (35 cardiac deaths), 19 (5%) nonfatal MI.The multiple regression model identified glycemia as the only independent determinant of Mg in AMI pts. (T value = − 2.8, standard coefficient = − 0.15, p < 0.01). The Kaplan–Meier survival estimates failed to show a significantly worst outcome in patients presenting low Mg (< 0.783 mmol/L, 25th percentile). Aging (> 67 years—50th percentile), and ejection fraction (< 40%) remained as prognostic factors for HE in the adjusted Cox multivariate proportional hazard model (HR = 2.8, 95% CI = 1.6–5, p < 0.001; HR = 3.2, 95% CI = 1.9–5.3 p < 0.001, respectively).ConclusionThe present findings do not support a significant role of low Mg as predictor for HE in AMI.

Prevalence of Hypomagnesaemia among Patients with Acute Myocardial Infarction and its Correlation to Intra-hospital Complications

“…One of the most interesting ndings of this study is that patients with normal magnesium levels and those with hypomagnesemia were more likely to be discharged (88%), and all dead patients had hypomagnesemia (100% do not support a signi cant role of low Mg as a predictor for prognosis and mortality in AMI [20,22,27], which corresponds to the result of our study.…”

Hypomagnesemia in critically ill patients

“…Over 6000 patients with ST-elevation myocardial infarction (STEMI) were randomized to receive intravenous Mg or placebo and the study found no effect of early administration of intravenous Mg on 30-day mortality [ 81 ]. One of the main criticisms against ISIS-4 was the timing of the Mg administration as ISIS-4 randomized participants until 24 h after onset of symptoms whereas previously animal studies have stated that Mg must be given within 6 h after vessel occlusion [ 82 , 83 ] for adequate effect. Moreover, Mg inhibits platelet activation by inhibiting Thromboxane A2 and interfering with the IIb-IIIa receptor complex [ 50 ], and Mg supplements are shown to inhibit platelet-dependent thrombosis in patients with coronary artery disease [ 84 ].…”

Prevention of Cardiovascular Disease: Screening for Magnesium Deficiency

“…Nevertheless, data regarding the protective role of Mg 2+ in the reduction of mortality after acute myocardial infarction are not all concordant, and there are conflicting results, such as the MAGIC (Mg 2+ in coronaries) trial that did not report any advantage of early Mg 2+ administration in addition to the standard therapy in high-risk patients after STEMI, with no effects on 30-day mortality [98]. Vassalle et al did not observe a significant role of low Mg 2+ levels in predicting hard events (all causes of death and nonfatal myocardial infarction) in patients after AMI [99]. The results found in these studies are probably due to the different population features, pointing out that Mg 2+ supplementation could exert the beneficial effect in low-risk patients with CVD or in prevention of CVD rather than in patients with high CV risk profiles.…”