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

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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 OR AND (exp magnesium sulfate OR magnesium OR magnesium OR exp magnesium OR exp OR exp magnesium chloride OR magnesium AND (exp arrhythmia OR OR OR exp ventricular fibrillation OR ventricular OR ( or (exp. mortality/ or] 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.

    Table 5


    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