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Best evidence topic report
Prophylactic magnesium in myocardial infarction
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  1. Mark Davies,
  2. Angaj Ghosh
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK

    http://dx.doi.org/10.1136/emj.18.2.119-a

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      Report by Mark Davies, Senior Clinical Fellow Search checked by Angaj Ghosh, Senior Clinical Fellow

      Clinical scenario

      You see a 50 year old man with a two hour history of cardiac chest pain and an ECG suggestive of acute myocardial infarction. You decide to thrombolyse. The cardiology registrar suggests that you also give intravenous magnesium to reduce the incidence of ventricular fibrillation. You wonder whether there is any evidence to support this.

      Three part question

      In [patients with suspected acute myocardial infarction] is [magnesium] effective at [reducing the incidence of ventricular fibrillation].

      Search strategy

      Medline 1966–11/00 using the OVID interface. [(exp myocardial infarction OR myocardial infarction.mp OR MI.mp) AND (exp magnesium sulfate OR magnesium sulfate.mp OR magnesium sulphate.mp OR exp magnesium OR exp magnesium.mp OR exp magnesium chloride OR magnesium chloride.mp) AND (exp arrhythmia OR arrhythmia.mp OR dysrhythmias.mp OR exp ventricular fibrillation OR ventricular fibrillation.mp OR (VF.mp) or (exp. mortality/ or mortality.mp)] AND maximally sensitive RCT filter LIMIT to human AND english.

      Search outcome

      Altogether 103 papers found of which 86 were irrelevant and 12 of insufficient quality for inclusion. The remaining five papers are shown in table 5.

      View this table:
      Table 5

      Comments

      A number of small studies published have suggested that magnesium therapy significantly improves mortality following myocardial infarction. While the two larger studies show a trend to reduction in the incidence of ventricular fibrillation but also demonstrates that this benefit is outweighed by an increased incidence of detrimental effects.

      Clinical bottom line

      Routine prophylactic magnesium in patients with myocardial infarction is not indicated.

      Report by Mark Davies, Senior Clinical Fellow Search checked by Angaj Ghosh, Senior Clinical Fellow

      References

      1. Abraham AS, Rosenmann D, Kramer M, et al. Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch Intern Med1987;147:753–5.
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      2. Roffe C, Fletcher S, Woods KL. Investigation of the effects of intravenous magnesium sulphate on cardiac rhythm in acute myocardial infarction. Br Heart J1994;71:141–5.
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      3. Bhargava B, Chandra S, Agarwal VV, et al. Adjunctive magnesium infusion therapy in acute myocardial infarction. Int J Cardiol1995;52:95–9.
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      4. Anonymous. ISIS 4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58050 patients with suspected acute myocardial infarction Lancet1995;345:669–85.
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      5. Gyamlani G, Parikh C, Kulkarni AG, et al. Benefits of magnesium in acute myocardial infarction: timing is crucial. Am Heart J2000;139:703.
        OpenUrlPubMed