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When the MAGIC stops: magnesium in acute coronary syndromes — a lesson in medical humility

Published online by Cambridge University Press:  21 May 2015

Shannon Patrick*
Affiliation:
Olive View–UCLA Medical Center, Sylmar, Calif
Mel Herbert
Affiliation:
KECK USC School of Medicine, LAC+USC Medical Center, Los Angles, Calif

Abstract

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There has been much debate as to whether magnesium, a well-tolerated, readily available and cheap therapy, should be used to treat patients with suspected myocardial infarction. Despite promising results from animal studies and small clinical trials conducted in the 1980s, two large recent trials have concluded that the once phenomenal treatment is ineffective. The story of magnesium for acute myocardial infarction is a lesson in medical humility.

Type
Medical Mythology • Mythes médicaux
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:34960.Google Scholar
2.Yusuf, S, Flather, M.Magnesium in acute myocardial infarction. BMJ 1995;310:7512.CrossRefGoogle ScholarPubMed
3.Ferrari, R, Albertini, A, Curello, S, Ceconi, C, Di Lisa, F, Raddino, R, et al. Myocardial recovery during post-ischemic reperfusion: effects of nifedipine, calcium, and magnesium. J Mol Cell Cardiol 1986;18:4878.CrossRefGoogle Scholar
4.Woods, KL.Possible pharmacological actions of magnesium in acute myocardial infarction. Br J Clin Pharmacol 1991;32:310.Google Scholar
5.Baxter, GF, Sumeray, MS, Walker, JM.Infarct size and magnesium: insights into LIMIT-2 and ISIS-4 from experimental studies. Lancet 1996;348:14246.CrossRefGoogle ScholarPubMed
6.Maxwell, S.Emergency management of acute myocardial infarction. Br J Clin Pharm 1999;48:28498.CrossRefGoogle ScholarPubMed
7.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;303:1499503.CrossRefGoogle Scholar
8.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;339:15538.CrossRefGoogle ScholarPubMed
9.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 1995;343:8169.Google Scholar
10.Yusuf, S, Teo, K, Woods, K.Intravenous magnesium in acute myocardial infarction: an effective, safe, simple, and inexpensive intervention. Circulation 1993;87:20436.CrossRefGoogle ScholarPubMed
11.ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. ISIS-4: a randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1995;345:66985.Google Scholar
12.Raghu, C, Peddeswara, RP, Seshagiri, RD.Protective effect of intravenous magnesium in acute myocardial infarction following thrombolytic therapy. Internat J Card 1999;71:20915.Google Scholar
13.Thogersen, AM, Johnson, O, Wester, PO.Effects of intravenous magnesium sulphate in suspected acute myocardial infarction on acute arrhythmias and long-term outcome. Internat J Card 1995;49:14351.Google Scholar
14.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;75:3213.Google Scholar
15.Antman, EM.Randomized trials of magnesium in acute myocardial infarction: big numbers do not tell the whole story. Am J Cardiol 1995;75:3913.Google Scholar
16.Antman, EM and The Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomized controlled trial. Lancet 2002;360:118996.CrossRefGoogle Scholar