心筋梗塞初発患者の血清マグネシウム値と院内予後予測との関連性

Serum Magnesium Level and It's Relation in Predicting Adverse In-Hospital Outcome in Patients with First Attack of Myocardial Infarction.

抄録

急性心筋梗塞（AMI）患者は、冠動脈治療室への入院患者の大きな割合を占めており、その管理とリスク層別化は非常に重要である。低マグネシウム血症は、心筋梗塞と不整脈の両方の長期的な危険因子である。我々は、急性心筋梗塞（AMI）患者において、入院時の血清マグネシウム濃度が不整脈および院内死亡率と関連するかどうかを評価した。本研究の目的は、急性心筋梗塞患者における血清マグネシウム値の予後への影響を評価することであった。この横断的観察研究は、2017年10月から2019年3月まで、Mymensingh Medical College Hospitalの循環器科で実施されました。合計259名の急性心筋梗塞患者を、包含基準と除外基準を考慮して対象とした。サンプル集団は2群に分けられた。Group-I：血清マグネシウム≧1.82mg/dlの急性心筋梗塞患者。グループ-II：急性心筋梗塞で血清マグネシウムが1.82mg/dl未満の患者。入院時に血清マグネシウム値を測定し、院内の主要な心イベントの発生率を評価した。本研究では、グループI、グループIIの平均血清マグネシウム濃度は、それぞれ2.21±0.14mg/dl、1.60±0.15mg/dlであった。統計学的に有意であった（p<0.05）。入院中の経過は，ローリスク群では入院期間中何ら問題なく経過し，合併症もなかった．I群では不整脈9例（4.8%）、心不全26例（13.9%）、心原性ショック9例（4.8%）、死亡3例（1.6%）であり、II群では不整脈44例（61.10%）、心不全9例（12.50%）、心原性ショック7例（9.7%）と死亡12例（16.7%）で統計的に有意な差が認められた（p＜0.05）。血清マグネシウム値による入院期間の平均は、I群4.27±0.68日、II群5.84±1.05日であり、統計的に有意であった（p<0.05）。結論として、血清マグネシウム値が1.82mg/dl未満の患者は、院内での不整脈および死亡のリスクが増加した。

Acute myocardial infarction (AMI) patients characterize a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. Hypomagnesemia is a long-term risk factor for incident of both myocardial infarction and arrhythmia. We assessed whether serum magnesium levels at admission is associated with arrhythmias and in-hospital mortality in patients with acute myocardial infarction (AMI). The aim of the study was to evaluate the prognostic implications of serum magnesium level in patients with acute myocardial infarction. This cross-sectional observational study was conducted in the department of cardiology in Mymensingh Medical College Hospital from October 2017 to March 2019. Total 259 acute myocardial infarction patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with acute myocardial infarction with serum magnesium ≥1.82mg/dl. Group-II: Patients with acute myocardial infarction with serum magnesium <1.82mg/dl. Serum magnesium level was measured on admission, and the incidence of in-hospital major cardiac events was assessed. In this study mean serum magnesium level of Group-I, Group-II were 2.21±0.14mg/dl, 1.60±0.15mg/dl respectively. It was statistically significant (p<0.05). In-hospital outcomes of the study group revealed that low risk group patients were uneventful outcome during hospitalization period, they had no any complication. In Group-I patient, 9(4.8%) were developed arrhythmias, 26(13.9%) were developed heart failure, 9(4.8%) were developed cardiogenic shock and 3(1.6%) were died and in Group-II patient, 44(61.10%) developed arrhythmias, 9(12.50%) were developed heart failure, 7(9.7%) were developed cardiogenic shock and 12(16.7%) were died out of them which was statistically significant (p<0.05). Mean duration of hospital stay of the study population according serum magnesium level was in Group-I, 4.27±0.68 days, in Group-II, 5.84±1.05 days which was statistically significant (p<0.05). In conclusion patient with serum magnesium level less than 1.82mg/dl increased the risk of in-hospital arrhythmia and death.