Meta-analysis Of Chinese Patent Medicine Intervention On Myocardial Injury In ACS Patients During PCI Perioperative Period

ObjectiveThe aim of this study was to evaluate and compare the efficacy of Chinese patent medicines in the prevention and treatment of peri-procedure myocardial injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention(PCI)by using network meta-analysis,so as to provide reference for clinical decision.MethodsDatabases including China National Knowledge Infrastructure(CNKI),Wanfang Database,Chinese Biomedical Database(CBM),Chinese Scientific Journal Database(VIP),PubMed,Embase,The Cochrane Library were searched for randomized controlled trials(RCT)on Chinese patent medicine intervention of peri-procedure myocardial injury in patients with ACS undergoing PCI.Two researchers independently screened literature and extracted data according to inclusion and exclusion criteria.The quality of the included studies was evaluated according to the Cochrane risk assessment tool.Stata14 and GeMTCO.14.3 softwares were used for network meta-analysis.Draw "evidence network diagram","network meta-analysis table","ranking probability chart","ranking probability table"and "funnel plot" according to different outcome indicators.To compare the efficacy of different Chinese patent medicine interventions with different outcome measures.ResultsA total of 95 studies with 9062 patients were included for analysis.The methodological quality of 3 researchs was grade A,80 researchs were grade B,and 12 researchs were grade C.17 kinds of Chinese patent medicines were involved.Network meta-analysis showed that:(1)In terms of reducing myocardial injury markers:1.For CK-MB index:A total of 56 studies involving 17 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Xuesaitong inj ection+RT>Ligustrazine inj ection+RT>Shengmai Inj ection+RT>Shenmai injection+RT>Tongxinluo capsule+RT>Danhong injection+RT>Ginkgo dipyridolum injection+RT>Tongguan capsule+RT>Compound Danshen dripping pills+RT>Safflower Yellow injection+RT>Suxiao Jiuxin pills+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>Shexiang Baoxin pills+RT>Shenyuan Yiqi Huoxue capsule+RT>Salvianolate injection+RT>Qishen Yiqi dripping pills+RT>Danshen Chuanxiongqin injection+RT>RT.2.For cTnI index:A total of 32 studies involving 13 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Shenmai injection+RT>Tongguan capsule+RT>Danshen Chuanxiongqin injection+RT>Suxiao Jiuxin pills+RT>Shengmai Injection+RT>Safflower Yellow injection+RT>Danhong injection+RT>Salvianolate injection+RT>Tongxinluo capsule+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>Shexiang Baoxin pills+RT>Compound Danshen dripping pills+RT>Qishen Yiqi dripping pills+RT>RT.(2)In terms of reducing inflammatory response:1.For hs-CRP index:A total of 43 studies involving 14 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Salvianolate injection+RT>Shengmai Injection+RT>Ligustrazine injection+RT>Danhong injection+RT>Suxiao Jiuxin pills+RT>Xuesetong injection+RT>Qishen Yiqi dripping pills+RT>Tongxinluo capsule+RT>Shenmai injection+RT>Shenyuan Yiqi Huoxue capsule+RT>Shexiang Baoxin pills+RT>Danshen Chuanxiongqin injection+RT>Safflower Yellow injection+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>RT.2.For IL-6 index:A total of 17 studies involvin 8C hinese patent medicines were included.The efficacy of all interventions was ranked as follows:Xuesetong injection+RT>Ginkgo dipyridolum injection+RT>Danhong injection+RT>Tongxinluo capsule+RT>Shenyuan Yiqi Huoxue capsule+RT>Danshen Chuanxiongqin injection+RT>Shengmai Injection+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>RT.(3)In terms of improving oxidative stress:1.For SOD index:A total of 22 studies involving 12 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Ginkgo dipyridolum injection+RT>Shexiang Baoxin pills+RT>Danhong inj ection+RT>Sa:fflower Yellow inj ection+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>Salvianolate injection+RT>Shenyuan Yiqi Huoxue capsule+RT>Shenmai injection+RT>Qishen Yiqi dripping pills+RT>Shengmai Injection+RT>Danshen Chuanxiongqin inj ection+RT>Tongguan capsule+RT>RT.2.For MDA index:A total of 18 studies involving 12 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Ginkgo dipyridolum injection+RT>Salvianolate injection+RT>Danhong injection+RT>Danshen Chuanxiongqin injection+RT>Shenyuan Yiqi Huoxue capsule+RT>Shenmai injection+RT>Shengmai Injection+RT>Sodium tanshinone Ⅱa sulfonate injection+RT>Qishen Yiqi dripping pills+RT>Tongxinluo capsule+RT>Shexiang Baoxin pills+RT>Safflower Yellow injection+RT>RT.(4)In terms of regulating vascellum endothelial function:1.For ET-1 index:A total of 20 studies involving 8 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Danhong inj ection+RT>Shexiang Baoxin pills+RT>Danshen Chuanxiongqin injection+RT>Salvianolate injection+RT>Ginkgo dipyridolum injection+RT>Qishen Yiqi dripping pills+RT>Shenmai injection+RT>Tongxinluo capsule+RT>RT.2.For NO index:A total of 20 studies involving 9 Chinese patent medicines were included.The efficacy of all interventions was ranked as follows:Shengmai Injection+RT>Tongxinluo capsule+RT>Ginkgo dipyridolum injection+RT>Shexiang Baoxin pills+RT>Salvianolate injection+RT>Shenmai injection+RT>Danhong injection+RT>Danshen Chuanxiongqin injection+RT>Sodium tanshinone Ⅱa sulfonate inj ection+RT>RT.ConclusionThe curative effect of some Chinese patent medicines combined with western routine treatment is better than that of western routine treatment alone in reducing perioperative myocardial injury,alle’viating postoperative inflammatory reaction,improving oxidative stress and regulating vascular endothelial function in patients with acute coronary syndrome during the perioperative period of PCI.Among them,Xuesaitong injection,Shenmai injection,Ligustrazine injection and Tongguan capsule may be the best choice to reduce the level of myocardial injury markers.Salvianolate injection,Xuesetong injection,Shengmai Injection and Ginkgo dipyridolum injection may be the best choice to alleviate postoperative inflammatory reaction.Ginkgo dipyridolum injection,Shexiang Baoxin pills and Salvianolate injection may be the best choice to improve oxidative stress.Danhong injection,Shengmai Injection,Shexiang Baoxin pills and Tongxinluo capsule may be the best choice to mediate vascular endothelial function.However,due to the small number of studies on each kind of Chinese patent medicine,the lack of direct comparative studies between different Chinese patent medicine,and the low quality of some research methods,the results of this study should be viewed cautiously and dialectically.