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 high in elderly patients and in patients who are not eligible for reperfusion therapy. Intravenous magnesium is a promising adjunctive treatment that may reduce reperfusion injury. Several earlier trials demonstrated a mortality rate reduction with magnesium treatment, but one large trial found no benefit. Study Design Magnesium in Coronaries (MAGIC) is a large, simple trial designed to maximize the potential treatment effect of magnesium. 10,400 high-risk patients with ST-elevation myocardial infarction will be randomly assigned to early treatment with intravenous magnesium sulfate or matching placebo. 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 effect. Implications If magnesium proves beneficial, its use will provide a simple, cost-effective means to improve survival in this large patient population. (Am Heart J 2000;139:10-4.)