Clinical Study On Treating Acute Coronary Syndrome With Blood-activating And Heat-clearing Decoction

[Objective] To explore TCM pathogenesis of Coronary Heart Disease(CHD), to observe the clinical efficacy and safety of Blood-activating and Heat-clearing Decoction for patients with acute coronary syndrome of CHD and to provide a theoretical basis and clinical evidence for Chinese medicine curing acute coronary syndrome.[Method] It is a prospective, randomized, single blind, parallel study. From the period of March 2009 to March 2010,100 patients were included in our study who met diagnostic criteria in the cardiology department of First Affiliated Hospital in Guangzhou university of Chinese medicine. This patients were divided in the control group (basic therapy of western medicine plus Coronary Decoction 2, B group,50 cases) and the treatment group (basic therapy of western medicine plus Blood-activating and Heat-clearing Decoction,A group, 50 cases). After 4 weeks of treatment, the score of TCM symptoms, the number and of duration of angina attacks were recorded in the Id,7d,14d,28d. Hs-CRP was detected in 7d before and after the treatment and platelet aggregation was detected in 28d before and after the treatment. Also, we make scores for the patients after treatment by the Seattle Angina Questionnaire.[Result]1. Baseline data analysis:A group:32 males and 18 females, in the age of 53.96±6.01 years, course of disease (6.53±1.55) years,28 patients with unstable angina,11 cases with ST segment elevation of myocardial infarction,11 cases with non-ST segment elevation of myocardial infarction, 6 patients with PCI in emergency,9 patients with PCI in elective. B group: 30 males and 20 females, in the age of 54.22±6.05 years, course of disease (6.27±1.67) years,26 patients with unstable angina,13 cases with ST segment elevation of myocardial infarction,11 cases with non-ST segment elevation of myocardial infarction and 7 patients with PCI in emergency, 12 patients with PCI in elective. There is no difference in gender, age, P>0.05, course of disease and disease distribution between these two groups.2. The overall effect of the two groups:For A group,30 patients have responded satisfatorily,8 patients have been produecd effect,12 patients have failed to respond to the treatment. For B group,10 patients have responded satisfatorily,13 patients have been produecd effect,27 patients have failed to respond to the treatment. After the statistical comparison, P <0.05, total effective rate was 76% in A group and 46% in B group.3. The total score of symptoms before and after these treatment:The total scores of symptoms before these treatment in A proup and B group were 26.90±2.31 and 34±2.06, Which showe no difference. The total scores of symptoms after these treatment in A group and B group were 12.02±3.59 and 21.42±10.61, which showed the total score of symptoms in A group is better than that of B group and there is statistically significant, P<0.05, between A group and B group.4. The analysis of the frequency and duration of angina attack before and after these treatment:Before and after these treatment, P>0.05, there is no difference in the frequency and duration of angina attack in these groups. The frequency and duration of angina attack is better after these treatment than that before these treatment.5. The analysis of the main symptoms indicators before and after these treatment:Before these treatment, P>0.05, there were no diference in points of chest tightness and chest pain. After the treatment of Blood-activating and Heat-clearing Decoction in A group, the symptoms of chest tightness and chest pain relieved and the symptom of chest pain relieved more in A group than that in B group.6. The analysis of the main symptoms indicators before and after these treatment:A secondary symptom index such as the points of palpitation, shortness of breath, fever, dry mouth, bitter mouth, thirst-hi cold, irritability, short red urine and stool dry showed no difference in these groups, P>0.05. After these treatment, these symptoms in A group relieved more that that in B group with statistical significance, P<0.05.7. The analysis of laboratory indicators before and after these treatment in these groups:There was significantly increased trend in hs-CRPand platelet aggregation before these treatment in two groups, which showed no difference bwtween two groups, P>0.05. After the treatment, the effect of hs-CRP, and platelet aggregation decresed and the effec of hs-CRP decresed significantly in A group than that in B group, P<0.05.8. the Comparison of the points of Seattle Angina Questionnaire after the treatment:There was significant difference of physical activity limitation, P<0.05, angina stability status and treatment satisfaction between two groups and those in A group were better than in B group. There were no difference in Angina pectoris and knowledge of the disease situation between two groups after treatment, P>0.05.[Conclusion] Noxious Heat and Stasis Syndrome was more common in acute coronarysyndrome in Lingnan. Blood-activating and Heat-clearing Decoction could decrease the effect of some objective indicators such as hs-CRP and platelet aggregation and relieve some subjective symptoms such as hest pain, chest tightness, palpitations, shortness of breath, dry mouth. There were no adverse effects in treatment.