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Pharmacokinetic-guided magnesium prophylaxis in cardiac surgery: A randomized trial demonstrating guideline-level reductions in atrial fibrillation, accelerated recovery, and systemic cost savings Cover

Pharmacokinetic-guided magnesium prophylaxis in cardiac surgery: A randomized trial demonstrating guideline-level reductions in atrial fibrillation, accelerated recovery, and systemic cost savings

Open Access
|Jan 2026

Figures & Tables

Postoperative Outcomes

ParameterMG GroupControl Groupp-valueStatistical Test
Atrial Fibrillation12 (18.5%)27 (41.5%)0.007Multivariable logistic regression (adjusted for age, EF)
ICU Stay (days)2.1 ± 0.83.5 ± 1.2<0.001ANCOVA (adjusted for surgery type)
Hospital Stay (days)6.2 ± 1.57.8 ± 2.1<0.001ANCOVA (adjusted for age, EF)
Ventilation Time (hrs)8.4 ± 3.111.6 ± 4.3<0.001Quantile regression (median)
Renal Impairment4 (6.2%)9 (13.8%)0.12Generalized linear model (log-binomial)
Rebleeding5 (7.7%)9 (13.8%)0.24Fisher’s exact test
Open chest3 (4.6%)5 (7.7%)0.47Fisher’s exact test
Stroke1 (1.5%)2 (3.1%)0.56Fisher’s exact test
Hypotension (SBP <90 mmHg)8 (12.3%)10 (15.4%)0.61Chi-square

Magnesium Levels Over Time
TimepointMG Group (mg/dL)Control Group (mg/dL)p-valueStatistical Test
Post-CPB2.8 ± 0.41.9 ± 0.3<0.001Linear mixed-effects model
ICU Arrival3.1 ± 0.52.0 ± 0.4<0.001Linear mixed-effects model
24 Hours Post-Op3.4 ± 0.62.1 ± 0.5<0.001Linear mixed-effects model

Subgroup Analysis by Surgery Type
Surgery TypeAF Incidence (MG)AF Incidence (Control)Adjusted OR (95% CI)p-value
CABG10/50 (20.0%)22/53 (41.5%)0.35 (0.15–0.82)0.01
AVR1/8 (12.5%)3/6 (50.0%)
MVR1/5 (20.0%)2/4 (50.0%)
AVR/MVR Pooled2/13 (15.4%)5/10 (50.0%)0.22 (0.04–1.25)0.09
Combined0/2 (0%)0/2 (0%)

Interaction Effects on AF Risk

SubgroupAdjusted OR (95% CI)p-valueInteraction p-value
Age ≥60 vs. <600.35 (0.14–0.87)0.020.21
Diabetes vs. No DM0.41 (0.19–0.91)0.030.45
CABG vs. Valve0.38 (0.15–0.94)0.040.18
DOI: https://doi.org/10.2478/jccm-2026-0001 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 95 - 101
Submitted on: Jun 29, 2025
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Accepted on: Nov 12, 2025
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Published on: Jan 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Sarah Hamdy Elghareeb, Islam Taher, Ahmed Abd Al Ghany, Noha Mohamed Abdelaziz, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.