ST elevation myocardial infarction magnesium therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Magnesium administration is associated with vasodilation and some mild antiplatelet effects. Magnesium administration is useful in the management of torsades de pointes.

Magnesium Therapy

Randomized Trial Data

The safety and effectiveness of magnesium in the management of STEMI patients was evaluated in a series of 15 studies enrolling 68,684 patients between 1980 and 2002. The randomized data does not support the routine administration of magnesium to patients with ST elevation MI. [1]

Indications

Magnesium can continue to be administered for repletion of documented electrolyte deficits and life-threatening ventricular arrhythmias such as torsade de pointes.[2][3]

2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT) [3]

Class III (Harm)
"1. In the absence of documented electrolyte deficits or torsade de pointes type VT, routine intravenous magnesium should not be administered to STEMI patients at any level of risk. (Level of Evidence: A)"
Class IIa
"1. It is reasonable that documented magnesium deficits be corrected, especially in patients receiving diuretics before the onset of STEMI. (Level of Evidence: C)"
"2. It is reasonable that episodes of torsade de pointes type VT associated with a prolonged QT interval be treated with 1 to 2 grams of magnesium administered as an IV bolus over 5 minutes. (Level of Evidence: C)"

Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [1]

References

  1. 1.0 1.1 Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869.  Unknown parameter |month= ignored (help)
  2. Woods KL, Abrams K (2002). "The importance of effect mechanism in the design and interpretation of clinical trials: the role of magnesium in acute myocardial infarction". Prog Cardiovasc Dis. 44 (4): 267–74. PMID 12007082. 
  3. 3.0 3.1 Antman EM, Anbe DT, Armstrong PW; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. PMID 15289388. doi:10.1161/01.CIR.0000134791.68010.FA.  Unknown parameter |month= ignored (help)

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