Rationale and design of the Magnesium in Coronaries (MAGIC) study: A clinical trial to reevaluate the efficacy of early administration of magnesium in acute myocardial infarction

Background Mortality rate from ST-elevation myocardial infarction remains h igh in elderly patients and in patients who are not eligible for reperfusio n therapy, intravenous magnesium is a promising adjunctive treatment that m ay reduce reperfusion injury. Several earlier trials demonstrated a mortali ty rate reduction with magnesium treatment, but one large trial found no be nefit. Study Design Magnesium in Coronaries (MAGIC) is a large, simple trial desig ned to maximize the potential treat ment effect of magnesium. 10,400 high-r isk patients with ST-elevation myocardial infarction will be randomly assig ned to early treatment with intravenous magnesium sulfate or matching place bo. The primary end point is death at 30 days. Information on the need for treatment of shock and sustained ventricular arrhythmias will be collected to investigate the mechanisms by which magnesium might exert a beneficial e ffect. Implications If magnesium proves beneficial, its use will provide a simple, cost-effective means to improve survival in this large patient population.