Abstract
In China, Chinese herbal medicine (CHM) is widely used as an adjunct to biomedicine (BM) in treating myocardial infarction (MI). This meta-analysis of RCTs evaluated the efficacy of combined CHM-BM in the treatment of MI, compared to BM alone. Sixty-five RCTs (12,022 patients) of moderate quality were identified. 6,036 patients were given CHM plus BM, and 5,986 patients used BM only. Combined results showed clear additional effect of CHM-BM treatment in reducing all-cause mortality (relative risk reduction (RRR) = 37%, 95% CI = 28%–45%, I 2 = 0.0%) and mortality of cardiac origin (RRR = 39%, 95% CI = 22%–52%, I 2 = 22.8). Benefits remained after random-effect trim and fill adjustment for publication bias (adjusted RRR for all-cause mortality = 29%, 95% CI = 16%–40%; adjusted RRR for cardiac death = 32%, 95% CI = 15%–46%). CHM is also found to be efficacious in lowering the risk of fatal and nonfatal cardiogenic shock, cardiac arrhythmia, myocardial reinfarction, heart failure, angina, and occurrence of total heart events. In conclusion, addition of CHM is very likely to be able to improve survival of MI patients who are already receiving BM. Further confirmatory evaluation via large blinded randomized trials is warranted.
Highlights
A total of 6,036 patients were enrolled in the Chinese herbal medicine (CHM) plus BM group, and 5,986 patients were allocated to the BM only group. e average size of the trials was 185 participants
Pooled results from another four randomized controlled trials (RCTs) reporting the occurrence of fatal cardiogenic shock favored combined treatment (RRR = 28%, 95% con dence intervals (CIs) = 5%–45%)
Twenty-three RCTs evaluated myocardial reinfarction, and the pooled result favors combined treatment (RRR = 52%, 95% CI = 39%–61%). e pooled results from 14 and 24 RCTs have favored combined treatment, respectively, in preventing cardiogenic shock (RRR = 37%, 95% CI = 15%–53%) and in alleviating angina symptoms (RRR = 53%, 95% CI = 46%–61%). ree RCTs investigated nonfatal cardiac rupture as an outcome. e pooled nding supports combined treatment but the estimate was statistically insigni cant (RRR = 56%, 95% CI = 67%–89%)
Summary
Current evidence on biomedicine (BM) treatment suggests that aspirin, thrombolytics with or without adding lowmolecular-weight heparin, beta-blockers, ACE inhibitors, and nitrates are bene cial for improving outcomes in people with MI. Invasive procedures including coronary artery bypass gra ing (CABG) and percutaneous transluminal coronary angioplasty (PTCA, balloon angioplasty) were found to be useful. Their efficacy in preventing death is not without limitations. Beta-blockers have no short-term effect on mortality, and they may increase the risk of cardiogenic shock. Rombolytics may cause stroke and major bleeding while reducing mortality, and those who are treated will receive no additional bene ts from nitrates [1] Beta-blockers have no short-term effect on mortality, and they may increase the risk of cardiogenic shock. rombolytics may cause stroke and major bleeding while reducing mortality, and those who are treated will receive no additional bene ts from nitrates [1]
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