Thögersen A M, Johnson O, Wester P O
Department of Internal Medicine, Umeå University, Sweden.
Int J Cardiol. 1995 Apr;49(2):143-51. doi: 10.1016/0167-5273(95)02299-c.
A total of 252 patients with suspected acute myocardial infarction were included in a double blind study and randomised to 50 mmol magnesium sulfate infusion under 20 h or corresponding placebo. Acute myocardial infarction was verified in 117 patients and 59% of these had concomitant treatment with thrombolysis. One-hundred ninety-four patients had Holter registrations during the first day in the coronary care unit. Intention-to-treat analysis showed an increase in long RR-intervals (> 3 s) in the magnesium treated group (P = 0.006) and a tendency toward a reduction in episodes of ventricular premature complexes in triplets (P = 0.09). During hospital stay and a mean of 22 months follow-up, 23 fatal events occurred in the magnesium allocated group and 31 fatal events among the placebo allocated group (P = 0.1). Mortality rate from cardiac disease was reduced by 54% (95% C.I. 30-99%, P < 0.05). Subgroup analysis on acute myocardial infarction patients showed a 48% mortality risk reduction in the magnesium treated acute myocardial infarction group compared to the placebo treated acute myocardial infarction group (95% C.I. 23-104%, P = 0.06). There was no significant interaction between the effects of magnesium and thrombolytic treatment on total mortality or cardiac events. This study supports the results of other small double blind placebo controlled studies regarding effects of magnesium therapy on mortality in acute myocardial infarction, but are in discordance to the conclusion from the ISIS-4 study. The reasons for these discrepancies cannot be elucidated by our data.
共有252例疑似急性心肌梗死患者纳入一项双盲研究，并随机分为两组，一组在20小时内静脉输注50 mmol硫酸镁，另一组输注相应的安慰剂。117例患者被证实为急性心肌梗死，其中59%同时接受了溶栓治疗。194例患者在冠心病监护病房的第一天进行了动态心电图记录。意向性分析显示，硫酸镁治疗组的长RR间期（>3秒）增加（P = 0.006），三联律室性早搏发作有减少趋势（P = 0.09）。在住院期间及平均22个月的随访中，硫酸镁组发生23例死亡事件，安慰剂组发生31例死亡事件（P = 0.1）。心脏病死亡率降低了54%（95%可信区间30 - 99%，P < 0.05）。对急性心肌梗死患者的亚组分析显示，与安慰剂治疗的急性心肌梗死组相比，硫酸镁治疗的急性心肌梗死组死亡风险降低48%（95%可信区间23 - 104%，P = 0.06）。硫酸镁和溶栓治疗对总死亡率或心脏事件的影响之间没有显著的相互作用。本研究支持其他小型双盲安慰剂对照研究关于镁疗法对急性心肌梗死死亡率影响的结果，但与ISIS - 4研究的结论不一致。我们的数据无法阐明这些差异的原因。
