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The Fourth International Study of Infarct Survival (ISIS-4) studied effects of oral mononitrates, oral captopril, and IV magnesium on mortality and major morbidity in patients with suspected acute MI. In this large trial, 58,050 patients were randomized in a 23232 factorial design to receive placebo or oral mononitrate (initially 30 mg daily then up to 60 mg daily for one month); placebo or oral captopril (6.25 mg initially titrated to 50 mg twice daily for one month); or 24 hours of IV magnesium (8 mmol bolus followed by 72 mmol) versus no treatment.
Of the 58,050 patients, 92% had confirmed MI, 74% were male, and 28% were over age 70. Median time to treatment was 8 hours; 79% had ST elevation on initial ECG; 70% received IV thrombolytic th…