Magnesium for treatment of acute lacunar stroke syndromes - Further analysis of the IMAGES trial

Stella Aslanyan*, Christopher J. Weir, Keith W. Muir, Kennedy R. Lees

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background and Purpose-A prespecified interaction analysis of the neutral Intravenous Magnesium Efficacy in Stroke ( IMAGES) trial revealed significant benefit from magnesium (Mg) in patients with noncortical stroke. Post hoc analysis indicated that this effect was seen in lacunar clinical syndromes (LACS), interaction P = 0.005. We have now examined whether this interaction could be explained by confounding baseline factors.

Methods-LACS was defined on the basis of neurological signs and did not include imaging. We investigated the interaction between baseline variables and Mg treatment on global outcome. We used logistic-regression models to test whether the Mg-LACS interaction remained significant after adjusting for stratification variables, sex, a novel stroke severity score, and baseline variables that had an interaction with treatment (P <0.1).

Results-The Mg (n = 383) and placebo (n = 382) groups of LACS patients were well matched on baseline factors. In addition to LACS, we found an interaction between beneficial Mg treatment effect and younger age (P = 0.003), higher baseline diastolic blood pressure (P = 0.02), higher mean blood pressure (P = 0.02), and absence of ischemic heart disease (P = 0.07). Even so, the adjusted Mg-LACS interaction remained significant (odds ratio [OR] 0.57; 95% CI, 0.39 to 0.83; P = 0.003). In the LACS subgroup, Mg improved Barthel Index <95 (OR 0.73; 95% CI, 0.55 to 0.98), modified Rankin Scale > 1 (OR 0.67; 95% CI, 0.50 to 0.91), and global outcome (OR 0.70; 95% CI, 0.53 to 0.92) but not Barthel Index <60 or mortality.

Conclusions-The positive treatment effect of Mg in LACS cannot be ascribed to general issues of severity, time to treatment, blood pressure, or other baseline factors; equally, this finding may be due to chance. A large trial of Mg treatment in LACS appears justified.

Original languageEnglish
Pages (from-to)1269-1273
Number of pages5
JournalStroke
Volume38
Issue number4
DOIs
Publication statusPublished - Apr 2007

Keywords / Materials (for Non-textual outputs)

  • clinical trials
  • lacunar syndrome
  • magnesium

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