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The Preventive Effect of Magnesium on Coronary Spasm in Patients With Vasospastic Angina^*

^* From the First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan.

Correspondence to: Hiroki Teragawa, MD, First Department of Internal Medicine, Hiroshima University School of Medicine, 1–2-3 Kasumi, Minamiku, Hiroshima, Japan 734-8851; e-mail: teragawa{at}mcai.med.hiroshima-u.ac.jp

Study objectives: Previous studies have reported that magnesium (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 in patients with vasospastic angina (VSA).

Design: Effectiveness trial.

Setting: University medical center.

Patients: Twenty-two patients with VSA.

Intervention: Coronary spasm was induced with an intracoronary infusion of acetylcholine (Ach). After spontaneous relief of the coronary spasm, Mg sulfate (0.27 mmol/kg body weight) was infused IV over 20 min in 14 patients and isotonic glucose was infused in 8 patients as control subjects. Intracoronary infusion of Ach was then repeated, and the diameter of the coronary arteries was measured quantitatively.

Measurements and results: Mg infusion caused coronary artery dilatation at baseline in both the spastic (5.9 ± 2.3%) and nonspastic segments (5.5 ± 1.5%). Mg infusion reduced the severity of chest pain and ST-segment deviations during coronary spasm. After the Mg infusion, the percent change in the diameter 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 infusion did 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 basal coronary dilatation and suppresses Ach-induced coronary spasm in patients with VSA.

Key Words: acetylcholine • magnesium sulfate • quantitative coronary angiography

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