![]() Magnesium is considered to be "nature's physiologic calcium blocker." This is because it protects myocytes against calcium overload by inhibiting calcium influx which is particularly important at the time of reperfusion. ![]() Supplemental administration of magnesium very early after the onset of acute myocardial infarction is supported by abundant data indicating potential cardioprotective effects of magnesium. Further, if it has the expected benefit in the high risk groups described, it would become an unusually cost-effective intervention, costing less than $2,500 per year of life saved. It is safe, even in the hands of physicians who have no prior experience with it and it is easily administered and readily available in any hospital in the United States. Of these, magnesium appears to be particularly promising. ![]() Recently, attention has turned to additional adjunctive pharmacologic treatment with agents such as magnesium, nitrates, and angiotensin converting enzyme inhibitors to determine their potential for reducing mortality further. However, the mortality rate remains high in two particular subgroups of patients: those who do not receive thrombolysis (11.5 to 13 percent) or those over 65 years who do receive thrombolytics (13.5 to 24 percent). Large randomized trials have demonstrated that aggressive reperfusion strategies in conjunction with aspirin can reduce mortality in patients with suspected acute MI to an average of 6.5 to 7.5 percent. Advances in the general coronary care unit environment, treatment with beta blockers, and aggressive attempts at reperfusion have all contributed to a reduction in mortality from acute MI. The management of patients with acute myocardial infarction (MI) has improved dramatically over the last three decades.
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