Abstract TP65: The Effect of Treatment with Magnesium on the Frequency of Cardiac Comorbidities in Hospitalized Stroke Patients
Background: Magnesium deficiency is associated with cardiac adverse events such as arrhythmias.
Objective: We aimed to determine whether early treatment with intravenous magnesium would lower the incidence of major cardiac events among ischemic and hemorrhagic stroke patients.
Methods: Subjects participated in the NIH Field Administration of Stroke Therapy Magnesium Clinical Trial (FAST-MAG), a phase 3 randomized blinded placebo-controlled study of prehospital initiation of magnesium sulfate (20 grams/24 hours) vs. placebo initiated within 2 hours of symptom onset. Serious cardiac adverse events were recorded and characterized in all participants. We determined the relationship of treatment with magnesium to overall and specific cardiac events.
Results: There were 1700 cases enrolled in the study with a mean age of 69, 42.7% female, with 1245 cases of cerebral ischemia and 387 cases of intracerebral hemorrhage. Overall there were 255 serious cardiac events recorded in 218 patients (13%), most often cardiac arrhythmia (186 events, 11% of patients) including newly diagnosed atrial fibrillation in 72 (4%), symptomatic bradycardia in 48 (3%) and cardiac arrest in 29 (2%). In subjects with a final diagnosis of cerebral ischemia, treatment with magnesium did not affect the number of overall cardiac adverse events (13.4% with magnesium vs. 14.1% with placebo) or arrhythmia-related events (11.6% magnesium vs 11.7% in placebo). Among cases with intracerebral hemorrhage, treatment with magnesium was associated with a non-significant increased number of serious adverse cardiac events (14% with magnesium vs. 8% with placebo, p = 0.052) and arrhythmia-related events (12.4% vs. 7.3%, p = 0.091). Factors associated with more frequent cardiac events in hospitalized stroke patients were increasing age, history of hypertension, coronary artery disease and atrial fibrillation.
Conclusions: Prehospital treatment with magnesium did not significantly reduce adverse cardiac events among patients with cerebral ischemia. There were more cardiac events reported in patients with ICH who received magnesium, a finding that may need to be further evaluated.
Author Disclosures: J. Noroozi: None. J.L. Saver: Other; Modest; Other; Modest; Dr. Saver is an employee of the University of California. The University of California, Regents receive funding for Dr Saver’s services as a scientific, consultant regarding trial design. The University of California, Regents receive funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to, Covidien, Stryker, BrainsGate, Pfizer & St. Jude Medical, Dr. Saver has served as an unpaid site investigator in multicenter trials run by Lundbeck for which UC Regents received, payments on basis of clinical trial contracts for the number of subjects enrolled, Dr. Saver serves as an unpaid consultant to Genentech advising on design & conduct of PRISMS trial;, neither Univ. of California nor Dr. Saver received any payments for this voluntary unpaid service. The University of California has patent rights in retrieval devices for stroke. D.S. Liebeskind: Research Grant; Significant; NIH-NINDS. Consultant/Advisory Board; Significant; Medtronic, Stryker. S. Starkman: None. S. Hamilton: None. K. Shkirkova: None. N. Sanossian: None.
- © 2017 by American Heart Association, Inc.