BMJ 1995;310:1669-1670 (24 June)

Letters

Magnesium in acute myocardial infarction

EDITOR,--Salim Yusuf and Marcus Flather1 offer no satisfactory explanation for the statistical incompatibility (P>0.0001 for heterogeneity) between the inefficacy of magnesium in the fourth international study of infarct survival (ISIS-4)2 and the clearly positive pooled results of the 10 other trials of intravenous magnesium in acute myocardial infarction. Magnesium has been reported to protect contractile function in a dozen experimental models of myocardial ischaemia and reperfusion and is now known to act during the first few minutes of reperfusion.3 4 ISIS-4 was unique in that most patients underwent thrombolysis before being randomised to magnesium or control (to accommodate the factorial design). The interval was not recorded but most typically have been three or more hours after randomisation took place at a mean of seven hours from the onset of symptoms. The 30% of patients in ISIS-4 who were not given thrombolytic treatment were randomised at a mean of 12 hours after . . . [Full text of this article]


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Relevant Article

Magnesium in acute myocardial infarction
Salim Yusuf and Marcus Flather
BMJ 1995 310: 751-752. [Extract] [Full Text]

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