Louise Pilote and colleagues have provided a timely stock taking of current treatments and outcomes of acute myocardial infarction.1 Commentator Arthur Dodek confidently assures the reader that with “contemporary specialized cardiology care the outcome may be as good as it gets.”2 However, effective alternatives to thrombolytic therapy and revascularization may be needed for patients who have a cardiac crisis far from a fully equipped hospital.
One modern modality perhaps overlooked in both articles is magnesium therapy. In terms of availability, effectiveness, safety and portability, parenteral magnesium would appear to offer the epitome of efficacy in such situations. It also has many features friendly to the heart.3
Much has been written about the ubiquitous magnesium salts, which until fairly recently were primarily used to treat gastrointestinal problems and preeclampsia. Seelig and colleagues outlined a wide range of studies showing positive results in acute myocardial infarction,4 one impressive large study being LIMIT-2.5 Whereas others demonstrated no benefit,6 Frakes and Richardson advocate the use of magnesium in a handful of emergency situations.7 The MAGIC study, involving 10 400 high-risk patients, is currently in progress8 and results are expected soon. I would like to see a study performed in which intravenous magnesium is given earlier than the 6-hour limit entered in the MAGIC protocol. Delaying and playing second fiddle may have contributed to the inferior results in some studies.6
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