ST elevation myocardial infarction magnesium therapy: Difference between revisions

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Latest revision as of 21:04, 28 January 2013

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

↑ ^1.0 ^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)
↑ 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.
↑ ^3.0 ^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. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[pmid15339869-1] 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)

[pmid12007082-2] 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.

[pmid15289388-3] 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. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
-{{Infobox_Disease |
-  Name           = Myocardial infarction|
-  Image          = |
-  Caption        = |
-  DiseasesDB     = 8664 |
-  ICD10          = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
-  ICD9           = {{ICD9|410}} |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = 000195 |
-  eMedicineSubj  = med |
-  eMedicineTopic = 1567 |
-  eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
-  MeshID         = |
-}}
-{{SI}}
-{{WikiDoc Cardiology Network Infobox}}
 __NOTOC__
-{{CMG}}
+{{ST elevation myocardial infarction}}
+{{CMG}};'''Associate Editor-In-Chief:''' {{CZ}}
-'''Associate Editor-In-Chief:''' {{CZ}}
+==Overview==
+[[Magnesium]] administration is associated with vasodilation and some mild antiplatelet effects.  Magnesium administration is useful in the management of [[torsades de pointes]].
-{{Editor Join}}
+==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.  <ref name="pmid15339869">{{cite journal |author=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 |title=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) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
-==Mechanism of Benefit==
+===Indications===
+Magnesium can continue to be administered for repletion of documented electrolyte deficits and life-threatening [[ventricular arrhythmia]]s such as torsade de pointes.<ref name="pmid12007082">{{cite journal |author=Woods KL, Abrams K |title=The importance of effect mechanism in the design and interpretation of clinical trials: the role of magnesium in acute myocardial infarction |journal=Prog Cardiovasc Dis |volume=44 |issue=4 |pages=267–74 |year=2002 |pmid=12007082 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0033062002500037}}</ref><ref name="pmid15289388">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, ''et al'' |title=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) |journal=Circulation |volume=110 |issue=5 |pages=588–636 |year=2004 |month=August |pmid=15289388 |doi=10.1161/01.CIR.0000134791.68010.FA |url=}}</ref>
-Between 1980 and 2002, a total of 68 684 patients were studied in a series of 15 randomized trials. On the basis of the totality of available evidence, in current coronary care practice, there is no indication for the routine administration of intravenous magnesium to patients with STEMI at any level of risk.
+==2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT) <ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=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). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref>==
-Magnesium can continue to be administered for repletion of documented electrolyte deficits and life-threatening ventricular arrhythmias such as torsade de pointes.<ref name="pmid12007082">{{cite journal |author=Woods KL, Abrams K |title=The importance of effect mechanism in the design and interpretation of clinical trials: the role of magnesium in acute myocardial infarction |journal=Prog Cardiovasc Dis |volume=44 |issue=4 |pages=267–74 |year=2002 |pmid=12007082 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0033062002500037}}</ref><ref name="pmid15289388">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, ''et al'' |title=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) |journal=Circulation |volume=110 |issue=5 |pages=588–636 |year=2004 |month=August |pmid=15289388 |doi=10.1161/01.CIR.0000134791.68010.FA |url=}}</ref>
+{|class="wikitable"
+|-
+|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
+|-
+|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+|}
-==Guidelines (DO NOT EDIT)==
+{|class="wikitable"
+|-
-===Class IIa===
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|-
-. It is reasonable that documented magnesium deficits be corrected, especially in patients receiving diuretics before the onset of STEMI. (Level of Evidence: C)
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable that documented [[magnesium]] deficits be corrected, especially in patients receiving [[diuretic]]s before the onset of [[STEMI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
-. 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)
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|}
-===Class III===
-. 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)
 ==Sources==
 *The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=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 |title=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) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
-*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 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: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
 ==References==
 {{reflist|2}}
-==External links==
+[[Category:Disease]]
-* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack] - based on information of the [[Framingham Heart Study]], from the United States [[National Heart, Lung and Blood Institute]]
-* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack] - overview of resources from [[MedlinePlus]].
-* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals] from the Heart and Stroke Foundation of Canada
-* [http://www.regionalpci-stemi.org/index.html Regional PCI for STEMI Resource Center] - Evidence based online resource center for the development of regional PCI networks for acute STEMI
-* [http://www.stemisystems.org/ STEMI Systems] - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
-* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
-* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site] - Information and resources for preventing, recognizing and treating heart attack.
-{{STEMI}}
 [[Category:Cardiology]]
+[[Category:Ischemic heart diseases]]
+[[Category:Intensive care medicine]]
 [[Category:Emergency medicine]]
+[[Category:Mature chapter]]
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