Volume 8, Issue 3 (Journal of Clinical and Basic Research (JCBR) 2024)
jcbr 2024, 8(3): 5-9 |
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SM L, Mohan N K, Sivam R, S A. Assessment of serum magnesium levels in patients with Acute Coronary Syndrome presenting within 48 hours of onset of symptoms to the emergency department in a tertiary care hospital. jcbr 2024; 8 (3) :5-9
URL: http://jcbr.goums.ac.ir/article-1-459-en.html
URL: http://jcbr.goums.ac.ir/article-1-459-en.html
1- Department of Emergency Medicine, Sree Gokulam Medical College & Research Foundation, Trivandrum, India
2- Emergency Medicine & Trauma Care, Government Medical College, Trivandrum, Kerala 695504, India
3- Department of Emergency Medicine, GG Hospital, Trivandrum, India ,sithusivam@gmail.com
4- Department of Cardiology, Government Medical College, Trivandrum, India
2- Emergency Medicine & Trauma Care, Government Medical College, Trivandrum, Kerala 695504, India
3- Department of Emergency Medicine, GG Hospital, Trivandrum, India ,
4- Department of Cardiology, Government Medical College, Trivandrum, India
Abstract: (438 Views)
Background: The aim of the study was to analyze serum magnesium (Mg) levels in patients with acute coronary syndrome (ACS) who presented within 48 hours of the onset of symptoms to the Emergency Department.
Methods: A total of 150 patients with ACS who presented within 48 hours of the onset of symptoms with chest pain and ECG changes suggestive of ACS were included. Serum Mg levels, along with sodium, potassium, calcium, and troponin levels, were measured.
Results: The majority of ACS cases occurred after the 6th decade of life (52.66%). Most patients in our study had non-ST-elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI) (48% vs 44%), and 8% of cases were of unstable angina. Recurrent myocardial infarction (MI) was observed in 34% of cases. Hypertension was present in 98 patients (65.33%), followed by diabetes (33.33%), and 54 patients (36%) had hyperlipidemia. Low serum Mg levels (< 1.8 mg%) were found in 54 patients (36%), 37 patients (24.66%) had serum Mg levels between 1.8 and 1.9 mg%, and 19.33% and 14% of cases had levels between 2 to 2.1 mg% and 2.2 to 2.3 mg%, respectively. Elevated serum Mg levels (≥ 2.4 mg%) were found in 6% of cases. Among the STEMI, NSTEMI, unstable angina, and recurrent MI cases, 33.33%, 40.27%, 25%, and 30.91%, respectively, had serum Mg levels < 1.8 mg%. The mean serum Mg levels among the low-risk, intermediate-risk, and high-risk ACS groups were 1.50 ± 0.71, 2.02 ± 0.32, and 1.72 ± 0.28, respectively (p < 0.05). The mean serum Mg level in the patients was 1.78 ± 0.32 on day 1 and 2.32 ± 0.44 on day 5. The mean serum Mg level was lower in recurrent MI patients than in those without recurrent MI (1.88 ± 0.34 vs 1.90 ± 0.31). Among the different types of STEMI, the mean serum Mg level was lowest in posterior wall MI (1.6). The mean serum Mg (mg%) levels in STEMI, NSTEMI, and unstable angina were 1.91 ± 0.28, 1.86 ± 0.32, and 1.97 ± 0.50, respectively. In recurrent MI patients, serum Mg was 1.88 ± 0.33. A significant positive correlation was found between serum sodium and serum Mg levels (r = 0.23, p = 0.004).
Conclusion: Low Mg levels were associated with higher disease severity. More studies are needed to determine whether serum Mg levels, along with other electrolyte levels, can be used as a complete electrolyte panel or as an adjuvant cardiac biomarker in the diagnosis and further management of ACS.
Methods: A total of 150 patients with ACS who presented within 48 hours of the onset of symptoms with chest pain and ECG changes suggestive of ACS were included. Serum Mg levels, along with sodium, potassium, calcium, and troponin levels, were measured.
Results: The majority of ACS cases occurred after the 6th decade of life (52.66%). Most patients in our study had non-ST-elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI) (48% vs 44%), and 8% of cases were of unstable angina. Recurrent myocardial infarction (MI) was observed in 34% of cases. Hypertension was present in 98 patients (65.33%), followed by diabetes (33.33%), and 54 patients (36%) had hyperlipidemia. Low serum Mg levels (< 1.8 mg%) were found in 54 patients (36%), 37 patients (24.66%) had serum Mg levels between 1.8 and 1.9 mg%, and 19.33% and 14% of cases had levels between 2 to 2.1 mg% and 2.2 to 2.3 mg%, respectively. Elevated serum Mg levels (≥ 2.4 mg%) were found in 6% of cases. Among the STEMI, NSTEMI, unstable angina, and recurrent MI cases, 33.33%, 40.27%, 25%, and 30.91%, respectively, had serum Mg levels < 1.8 mg%. The mean serum Mg levels among the low-risk, intermediate-risk, and high-risk ACS groups were 1.50 ± 0.71, 2.02 ± 0.32, and 1.72 ± 0.28, respectively (p < 0.05). The mean serum Mg level in the patients was 1.78 ± 0.32 on day 1 and 2.32 ± 0.44 on day 5. The mean serum Mg level was lower in recurrent MI patients than in those without recurrent MI (1.88 ± 0.34 vs 1.90 ± 0.31). Among the different types of STEMI, the mean serum Mg level was lowest in posterior wall MI (1.6). The mean serum Mg (mg%) levels in STEMI, NSTEMI, and unstable angina were 1.91 ± 0.28, 1.86 ± 0.32, and 1.97 ± 0.50, respectively. In recurrent MI patients, serum Mg was 1.88 ± 0.33. A significant positive correlation was found between serum sodium and serum Mg levels (r = 0.23, p = 0.004).
Conclusion: Low Mg levels were associated with higher disease severity. More studies are needed to determine whether serum Mg levels, along with other electrolyte levels, can be used as a complete electrolyte panel or as an adjuvant cardiac biomarker in the diagnosis and further management of ACS.
Keywords: Magnesium, Angina, Unstable, Acute Coronary Syndrome, Emergency Medicine, Myocardial Infarction
References
1. Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286-94. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Shechter M. Magnesium and cardiovascular system. Magnes Res. 2010;23(2):60-72. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Horner SM. Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Meta-analysis of magnesium in acute myocardial infarction. Circulation. 1992;86(3):774-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. DiNicolantonio JJ, Liu J, O'Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open heart. 2018;5(2):e000775. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Altura BM, Zhang A, Altura BT. Magnesium, hypertensive vascular diseases, atherogenesis, subcellular compartmentation of Ca2+ and Mg2+ and vascular contractility. Miner Electrolyte Metab. 1993;19(4-5):323-36. [View at Publisher] [PMID] [Google Scholar]
6. Patel UH, Jagrit NN, Madole MB, Panchal SS. Correlation of magnesium and calcium in the management of cardiac arrhythmia: Perspectives for better outcome. Adesh University Journal of Medical Sciences & Research. 2021;3(2):85-90. [View at Publisher] [DOI] [Google Scholar]
7. Lal L, Murmu H. Serum magnesium in patients with acute myocardial infarction. Int J Sci Study. 2016;4:167-9. [View at Publisher] [Google Scholar]
8. Deshpande A, Birnbaum Y. ST-segment elevation: distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies. World J Cardiol. 2014;6(10):1067. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Koca U. Acute Coronary Syndrome. Op Acc J Bio Sci & Res. 2020;2(1):1-8. [View at Publisher] [DOI] [Google Scholar]
10. Steg PG, Goldberg RJ, Gore JM, Fox KAA, Eagle KA, Flather MD, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 2002;90(4):358-63. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Baset M, Haque, Hoque A, Saha M, Barai L, Tareq Z, et al. Comparison of serum magnesium level (1-5 day) in patients with and without arrhythmias in patients with acute myocardial infarction. Eur J Pharm Med Res. 2020;7(9):56-61. [View at Publisher] [Google Scholar]
12. Abraham AS, Shaoul R, Shimonovitz S, Eylath U, Weinstein M. Serum magnesium levels in acute medical and surgical conditions. Biochem Med. 1980;24(1):21-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Dmitruk TA. [Plasma levels of magnesium and calcium in patients with ischemic heart disease]. Vrach Delo. 1977;(2):14-7. [View at Publisher] [PMID] [Google Scholar]
14. Sachdeva JR, Kumar A, Chander J. Serum magnesium levels and platelet adhesiveness in acute myocardial infarction. J Indian Med Assoc. 1978;71(7):165-7. [View at Publisher] [PMID] [Google Scholar]
15. Shafiq A, Goyal A, Jones PG, Sahil S, Hoffman M, Qintar M, et al. Serum Magnesium Levels and In-Hospital Mortality in Patients With Acute Myocardial Infarction. Circulation. 2016;134 (suppl_1):A17403. [View at Publisher] [Google Scholar]
16. Ramasamy R, Murugaiyan SB, Gopal N, Shalini R. The prospect of serum magnesium and an electrolyte panel as an adjuvant cardiac biomarker in the management of acute myocardial infarction. J Clin Diagn Res (JCDR). 2013;7(5):817-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Masuda M, Nakatani D, Hikoso S, Suna S, Usami M, Matsumoto S, et al. Clinical impact of ventricular tachycardia and/or fibrillation during the acute phase of acute myocardial infarction on in-hospital and 5-year mortality rates in the percutaneous coronary intervention era. Circ J. 2016;80(7):1539-47. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Goyal A, Spertus JA, Gosch K, Venkitachalam L, Jones PG, Van den Berghe G, et al. Serum potassium levels and mortality in acute myocardial infarction. JAMA. 2012;307(2):157-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Akila A, Anandraj J, Karthikayan S. Serum magnesium levels in acute myocardial infarction. IOSR J Dent Med Sci. 2017;16(5):35-40. [View at Publisher] [DOI] [Google Scholar]
20. Tan L, Xu Q, Li C, Liu J, Shi R. High-normal serum magnesium and hypermagnesemia are associated with increased 30-day in-hospital mortality: a retrospective cohort study. Front Cardiovasc Med. 2021;8:625133. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Efstratiadis G, Sarigianni M, Gougourelas I. Hypomagnesemia and cardiovascular system. Hippokratia. 2006;10(4):147-52. [View at Publisher] [PMID] [Google Scholar]
22. Qu X, Jin F, Hao Y, Li H, Tang T, Wang H, et al. Magnesium and the risk of cardiovascular events: a meta-analysis of prospective cohort studies. PloS one. 2013;8(3):e57720. [View at Publisher] [DOI] [PMID] [Google Scholar]
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