Assessment of serum magnesium levels in patients with Acute Coronary Syndrome presenting within 48 hours of onset of symptoms to the emergency department in a tertiary care hospital

Background: The aim of the study was to analyze serum magnesium (Mg) levels in patients with acute coronary syndrome (ACS) who presented within 48 hours of the onset of symptoms to the Emergency Department. Methods: A total of 150 patients with ACS who presented within 48 hours of the onset of symptoms with chest pain and ECG changes suggestive of ACS were included. Serum Mg levels, along with sodium, potassium, calcium, and troponin levels, were measured. Results: The majority of ACS cases occurred after the 6th decade of life (52.66%). Most patients in our study had non-ST-elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI) (48% vs 44%), and 8% of cases were of unstable angina. Recurrent myocardial infarction (MI) was observed in 34% of cases. Hypertension was present in 98 patients (65.33%), followed by diabetes (33.33%), and 54 patients (36%) had hyperlipidemia. Low serum Mg levels (< 1.8 mg%) were found in 54 patients (36%), 37 patients (24.66%) had serum Mg levels between 1.8 and 1.9 mg%, and 19.33% and 14% of cases had levels between 2 to 2.1 mg% and 2.2 to 2.3 mg%, respectively. Elevated serum Mg levels (≥ 2.4 mg%) were found in 6% of cases. Among the STEMI, NSTEMI, unstable angina, and recurrent MI cases, 33.33%, 40.27%, 25%, and 30.91%, respectively, had serum Mg levels < 1.8 mg%. The mean serum Mg levels among the low-risk, intermediate-risk, and high-risk ACS groups were 1.50 ± 0.71, 2.02 ± 0.32, and 1.72 ± 0.28, respectively (p < 0.05). The mean serum Mg level in the patients was 1.78 ± 0.32 on day 1 and 2.32 ± 0.44 on day 5. The mean serum Mg level was lower in recurrent MI patients than in those without recurrent MI (1.88 ± 0.34 vs 1.90 ± 0.31). Among the different types of STEMI, the mean serum Mg level was lowest in posterior wall MI (1.6). The mean serum Mg (mg%) levels in STEMI, NSTEMI, and unstable angina were 1.91 ± 0.28, 1.86 ± 0.32, and 1.97 ± 0.50, respectively. In recurrent MI patients, serum Mg was 1.88 ± 0.33. A significant positive correlation was found between serum sodium and serum Mg levels (r = 0.23, p = 0.004). Conclusion: Low Mg levels were associated with higher disease severity. More studies are needed to determine whether serum Mg levels, along with other electrolyte levels, can be used as a complete electrolyte panel or as an adjuvant cardiac biomarker in the diagnosis and further management of ACS.