The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients
Background. Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the e...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Cardiovascular Therapeutics |
| Online Access: | http://dx.doi.org/10.1155/2020/1494506 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850169159907803136 |
|---|---|
| author | Kameron Bechler Kristina Shkirkova Jeffrey L. Saver Sidney Starkman Scott Hamilton David S. Liebeskind Marc Eckstein Samuel Stratton Frank Pratt Robin Conwit Nerses Sanossian |
| author_facet | Kameron Bechler Kristina Shkirkova Jeffrey L. Saver Sidney Starkman Scott Hamilton David S. Liebeskind Marc Eckstein Samuel Stratton Frank Pratt Robin Conwit Nerses Sanossian |
| author_sort | Kameron Bechler |
| collection | DOAJ |
| description | Background. Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the effect of early initiation of high-dose intravenous magnesium sulfate on cardiac adverse events in stroke patients. Methods. This is a secondary analysis of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized phase-3 clinical trial, conducted from 2005-2013. Consecutive patients with suspected acute stroke and a serum magnesium level within 72 hours of enrollment were selected. Twenty grams of magnesium sulfate or placebo was administered in the ambulance starting with a 15-minute loading dose intravenous infusion followed by a 24-hour maintenance infusion in the hospital. Results. Among 1126 patients included in the analysis of this study, 809 (71.8%) patients had ischemic stroke, 277 (24.6%) had hemorrhagic stroke, and 39 (3.5%) with stroke mimics. The mean age was 69.5 (SD13.4) and 42% were female. 565 (50.2%) received magnesium treatment, and 561 (49.8%) received placebo. 254 (22.6%) patients achieved the target, and 872 (77.4%) did not achieve the target, regardless of their treatment group. Among 1126 patients, 159 (14.1%) had at least one CAE. Treatment with magnesium was not associated with fewer cardiac adverse events. A multivariate binary logistic regression for predictors of CAEs showed a positive association of older age and frequency of CAEs (R=1.04, 95% CI 1.03-1.06, p<0.0001). Measures of early and 90-day outcomes did not differ significantly between the magnesium and placebo groups among patients who had CAEs. Conclusion. Treatment of acute stroke patients with magnesium did not result in a reduction in the number or severity of cardiac serious adverse events. |
| format | Article |
| id | doaj-art-a67e697409cf4f84a2279efd8d572ccf |
| institution | OA Journals |
| issn | 1755-5914 1755-5922 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiovascular Therapeutics |
| spelling | doaj-art-a67e697409cf4f84a2279efd8d572ccf2025-08-20T02:20:48ZengWileyCardiovascular Therapeutics1755-59141755-59222020-01-01202010.1155/2020/14945061494506The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke PatientsKameron Bechler0Kristina Shkirkova1Jeffrey L. Saver2Sidney Starkman3Scott Hamilton4David S. Liebeskind5Marc Eckstein6Samuel Stratton7Frank Pratt8Robin Conwit9Nerses Sanossian10Keck School of Medicine, USAZilkha Neurogenetic Institute, University of Southern California, USAStroke Center and Department of Neurology, University of California, Los Angeles, USAStroke Center and Department of Neurology, University of California, Los Angeles, USAStanford University, USAStroke Center and Department of Neurology, University of California, Los Angeles, USADepartment of Neurology, University of Southern California, USAStroke Center and Department of Neurology, University of California, Los Angeles, USAStroke Center and Department of Neurology, University of California, Los Angeles, USADivision of Extramural Research, NIH/NINDS, USAKeck School of Medicine, USABackground. Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the effect of early initiation of high-dose intravenous magnesium sulfate on cardiac adverse events in stroke patients. Methods. This is a secondary analysis of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized phase-3 clinical trial, conducted from 2005-2013. Consecutive patients with suspected acute stroke and a serum magnesium level within 72 hours of enrollment were selected. Twenty grams of magnesium sulfate or placebo was administered in the ambulance starting with a 15-minute loading dose intravenous infusion followed by a 24-hour maintenance infusion in the hospital. Results. Among 1126 patients included in the analysis of this study, 809 (71.8%) patients had ischemic stroke, 277 (24.6%) had hemorrhagic stroke, and 39 (3.5%) with stroke mimics. The mean age was 69.5 (SD13.4) and 42% were female. 565 (50.2%) received magnesium treatment, and 561 (49.8%) received placebo. 254 (22.6%) patients achieved the target, and 872 (77.4%) did not achieve the target, regardless of their treatment group. Among 1126 patients, 159 (14.1%) had at least one CAE. Treatment with magnesium was not associated with fewer cardiac adverse events. A multivariate binary logistic regression for predictors of CAEs showed a positive association of older age and frequency of CAEs (R=1.04, 95% CI 1.03-1.06, p<0.0001). Measures of early and 90-day outcomes did not differ significantly between the magnesium and placebo groups among patients who had CAEs. Conclusion. Treatment of acute stroke patients with magnesium did not result in a reduction in the number or severity of cardiac serious adverse events.http://dx.doi.org/10.1155/2020/1494506 |
| spellingShingle | Kameron Bechler Kristina Shkirkova Jeffrey L. Saver Sidney Starkman Scott Hamilton David S. Liebeskind Marc Eckstein Samuel Stratton Frank Pratt Robin Conwit Nerses Sanossian The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients Cardiovascular Therapeutics |
| title | The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients |
| title_full | The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients |
| title_fullStr | The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients |
| title_full_unstemmed | The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients |
| title_short | The Effect of Early Treatment with Intravenous Magnesium Sulfate on the Incidence of Cardiac Comorbidities in Hospitalized Stroke Patients |
| title_sort | effect of early treatment with intravenous magnesium sulfate on the incidence of cardiac comorbidities in hospitalized stroke patients |
| url | http://dx.doi.org/10.1155/2020/1494506 |
| work_keys_str_mv | AT kameronbechler theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT kristinashkirkova theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT jeffreylsaver theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT sidneystarkman theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT scotthamilton theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT davidsliebeskind theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT marceckstein theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT samuelstratton theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT frankpratt theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT robinconwit theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT nersessanossian theeffectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT kameronbechler effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT kristinashkirkova effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT jeffreylsaver effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT sidneystarkman effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT scotthamilton effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT davidsliebeskind effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT marceckstein effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT samuelstratton effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT frankpratt effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT robinconwit effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients AT nersessanossian effectofearlytreatmentwithintravenousmagnesiumsulfateontheincidenceofcardiaccomorbiditiesinhospitalizedstrokepatients |