Magnesium Deficiency in Patients With Recent Myocardial Infarction and Provoked Coronary Artery Spasm

Abstract

agnesium (Mg) deficiency is one of the most important triggers of coronary artery spasm in patients with vasospastic angina. 1-3 Some researchers have reported that patients with variant angina have a Mg deficiency and intravenous administration of Mg suppresses the anginal attacks. [4][5][6] Magnesium lowers systemic vascular resistance, dilates the coronary arteries, improves myocardial metabolism and stabilizes cell membranes. 7 Variant angina has been associated with the incidence of myocardial infarction (MI), 8 and in patients who have had an acute MI (AMI), Mg administration improves serious fatal arrhythmias and may thus decrease the mortality rate. 9 Coronary artery spasm is implicated in the genesis of acute coronary syndrome, but no data exist concerning the relationship between Mg deficiency and coronary artery spasm in patients with a recent AMI.In order to clarify the possible role of Mg deficiency and coronary artery spasm in the genesis of AMI, a provocative test for coronary artery spasm was performed during the subacute phase of AMI, and the 24-h Mg retention after a Mg loading test was determined during both the acute and subacute phase in patients with AMI.Japanese Circulation Journal Vol.65, July 2001 Methods Study PatientsTwenty-three consecutive patients (19 men, 4 women; mean age, 64±7 years) with a recent AMI comprised the study group. All patients suffered from AMI and Killip I, and those whose AMI had been complicated with heart failure were excluded. The value of mean creatine kinase was 2,957±2,014 IU/L. Early coronary arteriography was performed during the acute phase in all 23 patients. Conventional balloon angioplasty was performed in 6 patients, intracoronary thrombolysis in 8 and the remaining 9 patients had conservative therapy. The infarct-related artery was the right coronary artery in 7 patients, the left circumflex artery in 3 and the left anterior descending artery in 13 patients. In the subacute phase, 18 patients had significant organic stenosis (>75% <90% luminal narrowing): 14 with 1-vessel and 4 with 2-vessel disease. The remaining 5 patients had no significant organic stenosis. In all patients, coronary stenosis in the infarct-related artery was less than 90%. Three patients had a history of old MI and 8 patients had post infarction angina attacks. As previously reported, 11-15 subjects were excluded and the spasm provocation test was not performed if patients had left main narrowing (>50%), 3-vessel disease, 2-vessel disease with total occlusion, heart failure (New York Heart Association functional class III or IV), or renal failure (creatinine >2.0 mg/dl), or if isosorbide dinitrate was initially used to relieve spasm in the coronary artery tested. During this study, neither death nor other complications occurred in the AMI patients.Twelve patients (9 men, 3 women; mean age, 58±5 years) This study sought to clarify the relationship between magnesium (Mg) deficiency and coronary artery spasm provoked by pharmacologic agents in patients with a recent acute myocardial...

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