The Application of Traditional Chinese Medicine Injection on Patients with Acute Coronary Syndrome during the Perioperative Period of Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Zhaofeng Shi,Qianqian Dai,Jiayuan Hu,Manke Guan,Changming Zhong,Chen Zhao,Guihua Tian,Hongcai Shang

doi:10.1155/2020/3834128

Abstract

Introduction TCMI with the effect of Liqihuoxue and Yiqihuoxue has been applied as complementary therapies during the perioperative period of PCI for patients with ACS, while the recommended time points and plans of TCMI are still short of the support of evidence-based medicine. Methods A systematic review and meta-analysis was conducted to evaluate the clinical efficacy and safety of TCMI on patients with ACS during the perioperative period of PCI. RCTs were searched based on standardized searching rules in seven medical databases from the inception up to August 2019. Two reviewers conducted the study selection, data extraction, and quality analysis independently. Data were analysed with the support of software RevMan and Stata. Results A total of 68 articles with 6,043 patients were enrolled. The result of meta-analysis showed that the TCMI combined with western medicine was superior to the western medicine alone on clinical efficiency (before the PCI, before and after the PCI, or overall, P < 0.05), the occurrence of MACE (myocardial infarction and stenocardia: before the PCI, before and after the PCI, or overall, P < 0.05; arrhythmia: before and after the PCI, P < 0.05), and the level of inflammatory factors (hs-CRP: before the PCI, before and after the PCI, or overall, P < 0.05; IL-6: after the PCI, P < 0.05). The TCMI with the effect of Liqihuoxue obtained more support compared with Yiqihuoxue based on the result of meta-analysis. Conclusions TCMI with the effect of Liqihuoxue or Yiqihuoxue combined with western medicine generally showed the potential advantage on the treatment of ACS during the perioperative period of PCI. However, the optimal time point of intervention and recommended plan based on the effect still needs more clinical evidence. We consider that the research of precise and standardized application of TCMI will be a promising direction for TCM in the future.

Highlights

traditional Chinese medicine injection (TCMI) with the effect of Liqihuoxue and Yiqihuoxue has been applied as complementary therapies during the perioperative period of percutaneous coronary intervention (PCI) for patients with Acute coronary syndrome (ACS), while the recommended time points and plans of TCMI are still short of the support of evidence-based medicine
Acute coronary syndrome (ACS), which is caused by rupture or erosion of atherosclerotic plaque in the coronary artery or fresh thrombosis, can be classified as unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and STelevation myocardial infarction (STEMI) based on the electrocardiographic changes and cardiac biomarker [1]
As for the clinical score for risk stratification, the PRECISE-DAPT [11] and the CRUSADE bleeding score [12] has proved its value on the prediction of the risk of bleeding events; the Global Registry of Acute Coronary Events (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score have identified the effect on the evaluation of ischemia risk [13]

Summary

Introduction

TCMI with the effect of Liqihuoxue and Yiqihuoxue has been applied as complementary therapies during the perioperative period of PCI for patients with ACS, while the recommended time points and plans of TCMI are still short of the support of evidence-based medicine. A systematic review and meta-analysis was conducted to evaluate the clinical efficacy and safety of TCMI on patients with ACS during the perioperative period of PCI. E TCMI with the effect of Liqihuoxue obtained more support compared with Yiqihuoxue based on the result of meta-analysis. TCMI with the effect of Liqihuoxue or Yiqihuoxue combined with western medicine generally showed the potential advantage on the treatment of ACS during the perioperative period of PCI. Basic treatments for ACS include dual antiplatelet (such as aspirin and P2Y12 inhibitors) [14], anticoagulant (such as fondaparinux and low-molecular-weight heparin) [15], and anti-ischemic (such as beta-blockers) [16] therapies. e treatment of revascularization includes the percutaneous coronary intervention (PCI), thrombolytic therapy (tissue plasminogen activator), and coronary artery bypass grafting (CABG) [17]

Results

Discussion

Conclusion