Santoro G M, Antoniucci D, Bolognese L, Valenti R, Buonamici P, Trapani M, Santini A, Fazzini P F
Division of Cardiology, Careggi Hospital, Florence, Italy.
Am Heart J. 2000 Dec;140(6):891-7. doi: 10.1067/mhj.2000.110767.
Notwithstanding the negative result of the International Study of Infarct Survival-4 (ISIS-4), the controversy about the role of magnesium in acute myocardial infarction is still open because, according to experimental data, magnesium could decrease myocardial damage and mortality only if infusion is started before reperfusion. This randomized placebo-controlled trial was designed to evaluate the effect of intravenous magnesium, delivered before, during, and after direct coronary angioplasty, in patients with acute myocardial infarction.
One-hundred fifty patients were randomized to intravenous magnesium sulfate or placebo. The primary end point was an infarct zone wall motion score index at 30 days, as a measure of infarct size. The secondary end points included creatine kinase peak, ventricular fibrillation/tachycardia within the first 24 hours, death and congestive heart failure within the 30-day follow-up, and 30-day left ventricular ejection fraction. Analysis was by intention to treat.
There were no significant differences between the magnesium and placebo groups in the 30-day infarct zone wall motion score index (1.93 +/- 0.61 vs 1.85 +/- 0.51, P =.39), ventricular arrhythmias (24% vs 15%, P =.15), death (0 vs 1%, P =.32), heart failure (8% vs 7%, P =.75), and 30-day left ventricular ejection fraction (49% +/- 11% vs 50% +/- 9%, P = 0.55). There was a trend toward a higher creatine kinase peak in the magnesium group (3059 +/- 2359 vs 2404 +/- 1673,P =.052).
Intravenous magnesium delivered before, during, and after reperfusion did not decrease myocardial damage and did not improve the short-term clinical outcome in patients with acute myocardial infarction treated with direct angioplasty.
尽管国际心肌梗死存活研究-4（ISIS-4）的结果为阴性，但镁在急性心肌梗死中的作用仍存在争议，因为根据实验数据，镁只有在再灌注前开始输注才能减少心肌损伤和死亡率。本随机安慰剂对照试验旨在评估在直接冠状动脉血管成形术之前、期间和之后静脉输注镁对急性心肌梗死患者的影响。
150例患者被随机分为静脉输注硫酸镁组或安慰剂组。主要终点是30天时梗死区域壁运动评分指数，作为梗死面积的衡量指标。次要终点包括肌酸激酶峰值、最初24小时内的室颤/室速、30天随访期内的死亡和充血性心力衰竭以及30天左心室射血分数。分析采用意向性治疗。
镁组和安慰剂组在30天时的梗死区域壁运动评分指数（1.93±0.61对1.85±0.51，P = 0.39）、室性心律失常（24%对15%，P = 0.15）、死亡（0对1%，P = 0.32）、心力衰竭（8%对7%，P = 0.75）以及30天左心室射血分数（49%±11%对50%±9%，P = 0.55）方面均无显著差异。镁组肌酸激酶峰值有升高趋势（3059±2359对2404±1673，P = 0.052）。
在再灌注之前、期间和之后静脉输注镁并不能减少急性心肌梗死患者接受直接血管成形术时的心肌损伤，也不能改善其短期临床结局。
