Objectives

To determine whether early intravenous magnesium treatment of patients with suspected acute myocardial infarction reduces mortality.

Background

Mortality rate from ST-elevation myocardial infarction (STEMI) remains high in elderly patients and in patients who are not eligible for reperfusion therapy. Intravenous magnesium is a promising adjunctive treatment that may reduce reperfusion injury. Several earlier trials demonstrated a mortality rate reduction with magnesium treatment, but one large trial found no benefit. If magnesium proves beneficial, its use will provide a simple, cost-effective means to improve survival in this large patient population.

Participants

Magnesium in Coronaries (MAGIC) is a large, simple trial designed to maximize the potential treatment effect of magnesium. A total of 6,213 high-risk patients with ST-elevation myocardial infarction were randomly assigned to early treatment with intravenous magnesium sulfate or matching placebo. The primary end point was death at 30 days. Information on the need for treatment of shock and sustained ventricular arrhythmias were collected to investigate the mechanisms by which magnesium might exert a beneficial effect.

Conclusions

Early administration of magnesium in high-risk patients with STEMI had no effect on 30-day mortality. There was no indication for the routine administration of magnesium in patients with STEMI (LANCET 2002; 360: 1189-1196).

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