Chest
Volume 118, Issue 6, December 2000, Pages 1690-1695
Journal home page for Chest

Clinical Investigations
CARDIOLOGY
The Preventive Effect of Magnesium on Coronary Spasm in Patients With Vasospastic Angina

https://doi.org/10.1378/chest.118.6.1690Get rights and content

Study objectives:

Previous studies have reported thatmagnesium (Mg) deficiency is associated with coronary spasm. However, little is known about the preventive effect of Mg on coronary spasm. The present study investigated whether Mg prevents coronary spasm inpatients with vasospastic angina (VSA).

Design:

Effectiveness trial.

Setting:

University medicalcenter.

Patients:

Twenty-two patients with VSA.

Intervention:

Coronary spasm was induced with anintracoronary infusion of acetylcholine (Ach). After spontaneous reliefof the coronary spasm, Mg sulfate (0.27 mmol/kg body weight) wasinfused IV over 20 min in 14 patients and isotonic glucose was infusedin 8 patients as control subjects. Intracoronary infusion of Ach wasthen repeated, and the diameter of the coronary arteries was measuredquantitatively.

Measurements and results:

Mg infusioncaused coronary artery dilatation at baseline in both the spastic(5.9 ± 2.3%) and nonspastic segments (5.5 ± 1.5%). Mg infusionreduced the severity of chest pain and ST-segment deviations duringcoronary spasm. After the Mg infusion, the percent change in thediameter of the spastic segments improved from − 62.8 ± 2.6% to−43.7 ± 4.7% during coronary spasm. Overall, 10 of 14 patients(71%) responded favorably to Mg infusion. Isotonic glucose infusiondid not elicit changes in chest pain severity, ST-segment deviations, or the diameter of the coronary arteries during spasm.

Conclusions:

Mg infusion produces nonsite-specific basalcoronary dilatation and suppresses Ach-induced coronary spasm inpatients with VSA.

Section snippets

Study Subjects

We studied 22 Japanese patients with VSA (mean age, 57 years; range, 43 to 69 years; 19 men, 3 women) who fulfilled the followinginclusion criteria: (1) spontaneous chest pain associated with, ST-segment elevation or depression on 12-lead ECG or ambulatory ECG atrest; (2) coronary spasm (≥ 50% reduction of the diameter of theartery during coronary angiography) in the left coronary artery (LCA)associated with ST-segment changes and/or typical chest pain afterintracoronary injection of Ach; and

Clinical Characteristics

The clinical characteristics of the studied patients are listed inTable 1. No significant differences in the clinical characteristics existedbetween the Mg and control groups.

In the Mg group, coronary spasm was induced in seven patients byintracoronary Ach infusion at a dose of 30 μg/min, and in theremaining seven patients at a dose of 100 μg/min. In the controlgroup, coronary spasm was induced in five patients at a dose of 30μg/min, and in the remaining three patients at a dose of 100μg/min.

Discussion

The present study demonstrates that Mg infusion reduces, Ach-induced coronary spasm, improving not only chest symptoms and, ST-segment shift but also QCA findings in the majority of patients with, VSA. Coronary angiography confirms that Mg infusion dilates thecoronary arteries at baseline and attenuates the vasoconstriction inthe spastic segments of the coronary arteries in response to Ach.

Conclusion

Mg infusion causes nonsite-specific dilation of the coronaryarteries and suppresses Ach-induced coronary spasm inpatients with VSA. These findings suggest that IV Mg infusion may havetherapeutic application in modulating the increased coronary tonus inpatients with ischemic heart disease associated with coronary spasm. Furthermore, these results suggest that long-term oral Mgsupplementation might prevent or reduce coronary spasm in patients with, VSA.

References (27)

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