| Coronary heart disease is the most common type of diseases caused by coronary artery spasm, stenosis and thrombosis based on atherosclerosis, which refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. Recently, there is magnitude development of research on relationship between the characteristics of coronary artery lesion and the syndrome of Traditional Chinese Medicine (TCM). But most of previous researches were the descriptive analysis of coronary artery lesion, and lack of comprehensive and quantitative studies. To comprehensively evaluate the coronary artery lesion of patients, we use Gensini score and corrected TIMI frame counts (CTFC) and TIMI myocardial perfusion grade (TMP). The relationship between blood-stasis, its accompanied syndrome and coronary artery lesion, Gensini score, CTFC, TMP were analyzed in coronary heart disease patients who were in the stable condition. We also observe the effects of Chinese drugs for supplementing Qi and activating blood circulation in patients with acute coronary syndrome after percutaneous coronary intervention. This study is divided into two parts:Part 1:The Analysis of Coronary Pathological Characteristics and Blood-stasis Syndrome in CHD Patients in the Stable ConditionObjective:To comprehensively evaluate the coronary pathological characteristics and myocardial perfusion of CHD patients who were in the stable condition, and analyze their relationship to the blood-stasis syndrome (BSS) and its accompanied syndromes, and observe their effects to the occurrence of cardiovascular events.Methods:369 CHD patients enrolled from several hospitals August to December in 2008, whose coronary heart disease was confirmed by coronary angiography. The syndrome types of TCM, especially BSS and its accompanied syndrome, and blood-stasis score and symptom score in TCM were recorded. Gensini score and CTFC and TMP grade were calculated according coronary pathological characteristics showed by angiography. The relationship between BSS score to Gensini score, CTFC and TMP were analyzed. On this basis, the differences of the characteristics of coronary, Gensini score, CTFC, TMP and BBS score were observed among the patients of different types of syndromes of TCM, especially BSS and its accompanied syndrome. The difference of the characteristics of coronary, Gensini score, CTFC, TMP and BBS score was also observed between the patients with BBS score no less than 11 and those less than 11. And the difference of the characteristics of coronary, Gensini score, CTFC, TMP, BBS score and the type of syndrome of TCM was also observed in patients with cardiovascular events occurrence and those without.Results:In 369 CHD patients who were in stable condition,169 patients were in BBS of TCM, and the other 200 patients were in non-BBS. Besides the BSS, the other five common syndromes in 369 patients were the turbid-phlegm, Qi-stagnation, Qi-deficiency, Yin-deficiency and Yang-deficiency syndrome, which revealed in 143 patients (38.8%),14 patients (3.8%),206 patients (55.8%),68 patients (18.4%) and 58 patients (15.7%), respectively. Compared to non-BSS patients, the patients with BSS, phlegm and blood-stasis syndrome, Qi-deficiency and blood-stasis syndrome have higher Gensini score (P<0.05 or P<0.01), and lower TMP grade in patients with BSS, phlegm and blood-stasis syndrome, Yang-deficiency and blood-stasis syndrome(P<0.05). The CTFC in patients with Qi stagnation was more than that in patients without Qi stagnation (P<0.05). The patients with BSS score no less than 11 had more and longer artery lesion than that with BSS score less than 11 (P=0.049,P=0.031), but no significant difference were found in stents length, Gensini score, CTFC and TMP (P>0.05). Besides, with bivariate analysis, the BBS score showed correlation with lesion length (Person correlation coefficient: 0.175,P=0.045), and non with the others (P>0.05). TMP grade was higher in the patients with phlegm and blood-stasis syndrome than that with none. The patients with BSS, phlegm and blood-stasis syndrome, Qi-deficiency and blood-stasis syndrome have higher risk of occurrence of cardiovascular events (P<0.05 or P<0.01) than the patients without the syndromes. The more artery lesion and lower myocardial perfusion grade, the more cardiovascular events happen.Conclusion:Qi-deficiency, blood-stasis and turbid-phlegm are the main effects on patients who were in the stable condition. According to the severe coronary lesion and worse myocardial perfusion, the patients with BSS and accompanied syndrome with phlegm have more occurrences of cardiovascular events.Part 2:The Clinical Trial of Chinese herbs for Supplementing Qi and Activating Blood Circulation on Patients with Acute Coronary Syndrome after Percutaneous Coronary InterventionObjective:To observe the effects of Chinese drugs for supplementing Qi and activating blood circulation in patients with acute coronary syndrome after percutaneous coronary intervention on the occurrence of cardiovascular events and symptoms of angina and symptoms of TCM and blood-stasis scrore, with different lever of myocardial perfusion.Methods:241 patients with acute coronary syndrome, who had received revascularization by percutaneous coronary intervention successfully, were randomized into the treated group and the control group, both treated with conventional Western medical treatment, but combined, respectively, with Xinyue Capsule plus Compound Chuanxiong Capsule for 6 months. Gensini score was calculated to evaluate the coronary pathological characteristics, CTFC and TMP grade to evaluate myocardial perfusion showed by the angiography during PCI. The occurrence of cardiovascular events in 1 year, symptom of angina and TCM, BSS score recorded at entry and 1 year after percutaneous coronary intervention to estimate the effect of the Chinese drugs of supplementing Qi and activating blood circulation in ACS patients.Results:The baseline between the two groups was similar. There is no significant difference in angina score and the reduction of the score between the two groups at entry and 1 year (P>0.05). The comparison of symptom score of TCM between the two groups showed that the patients in treated group have higher symptom score of TCM at entry and higher reduction than those in the control group (P<0.05), but no significant difference at 1 year (P>0.05). No significant difference of BSS score and the reduction between the two groups at entry and 1 year (P>0.05) No significant difference in angina score, symptom score in TCM and BSS score was found between the two groups at entry in subgroup analysis of the patients with Gensini score more than 24 points (P>0.05). To the patients with Gensini score less than 24 points, no significant difference of angina score at entry and 1 year was found between the two groups. There are significant differences of symptom score in TCM at 1 year and the reduction between the treated group and the control one (P<0.05). The BSS score in the patients of treated group was less than those in control at 1 year. In the subgroup analysis of patients with CTFC more than 28, there is no significant difference of angina score, symptoms score in TCM and BSS score between the two groups (P>0.05), neither in patients with CTFC less than 28 (P>0.05). To analyze the occurrence of cardiovascular events, no significant difference was found between the two groups, neither in subgroup analysis of TMP grade 2 and TMP grade 3.Conclusion:For the reason that Qi-deficiency and blood stasis are the most common factors that effects the symptom of ACS patients, therapy with Chinese drugs for supplementing Qi and activating blood circulation in combination with conventional Western medical treatment could obviously improve the symptom in TCM, especially to the ACS patients with lower risk of coronary pathological characteristics, it also could improve the angina symptom of 1 year to the patients with high risk of coronary pathological characteristics.
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