| Background:Danshen(Salvia Miltiorrhiza,SM)is a representative herb for activating blood circulation and removing blood stasis.Danshen based injections are made of extracts of salvia miltiorrhiza,which are often used for the treatment of ischemic cardio-cerebrovascular diseases,such as myocardial infarction,cerebral infarction and cardiac arrhythmias caused by stasis of the heart and blood vessels.Atrial fibrillation is one of the most common arrhythmias complicated with acute myocardial infarction(MI)with an incidence of about 10%-20%.Atrial fibrillation(Af)in the early stages of acute myocardial infarction is associated with many risk factors,such as aging,state of cardiac function.The co-occurrence of these two diseases is much more common in the elderly population.Acute myocardial infarction complicated with atrial fibrillation aggravates myocardial ischemia,enlarges infarct area,and increases short-term and long-term mortality.Therefore,it is necessary to positively treat the complicated atrial fibrillation and to have a better understand of the risk factors of atrial fibrillation.Based on the above situation,this study applied Meta analysis to evaluate the efficacy and safety of the combined treatment with Danshen injections and antiarrhythmic drugs for acute myocardial infarction with atrial fibrillation.Rregression analysis was applied to study the correlation between aging and the efficacy of such combined treatment,so as to promote its safe and rational use.Methods:1.Literature researching.This study reviewed literatures about the mechanism of danshen and danshen based injections promoting blood circulation and remove blood stasis.Then researches on sorts of danshen based injections and their active ingredients were reviewed and mechanism of their protective effect on myocardial cells against myocardial infarction injuries were summarized.The pharmacological mechanisms of danshen igredients suppressing the onset and maintaining of arrhythmia such as atrial fibrillation was also summarized.Then this study reviewed risk factors of acute myocardial infarction and atrial fibrillation and how aging influence the onset and maintaining of atrial fibrillation.At last,this study reviewed literature about the current state of systemic review and meta-analysis in order to choose a better way do the later systemic review.2.Meta and regression analysis.We searched the studies of randomized controlled trials(RCTs)on the treatment of coronary heart diseases complicated with arrhythmia.We then selected the articles compared the efficacy and safety of two treatment:one combined treatment of both antiarrhythmic drugs and danshen extracts based injections,and the other antiarrhythmic drugs solely.Regardless of whether allocation hiding/blind method is applied or not,the language used is limited to Chinese and English.Meta-analysis was performed with Stata/MP 14.0 software for the comparison of different interventions.The odds ratio(OR)or risk ratio(RR)was calculated for the binary outcomes,and the mean difference(MD)or standardized mean difference(SMD)for continuous outcomes.The MD or the SMD or the ratio of mean(RoM)were calculated for 95%Confidence Interval(CI).The heterogeneity between studies was analyzed byχ~2 test,and I~2 is for evaluating the size of heterogeneity,when P>0.1 and I~2<50%,Meta-analysis is performed on fixed effect model(M-L method,the Mantel&Haenszel method),otherwise performed on random effects model(D-L method,the DerSimonian&Laird method;heterogeneity were analyzed using the Mantel&Haenszel method)after heterogeneity sources had been excluded.Inaddition,regression analysis between the efficacy indicators and aging was conducted to figure out whether aging has an influence on the efficacy of the combined treatment.Results:9 studies were included,with a total of 870 patients,443in the intervention group and 427 in the control group.The outcome indicators reported include success rate of Af conversion,recurrence rate of Af,incidence of heart failure,mortality during hospitalization,changes in serum CRP level before and after treatment,and ventricular rate at different time points in the course of treatment.6 studies reported the success rate of atrial fibrillation conversion,with a total of 562 cases,showing little inter-study heterogeneity.6studies reported the recurrence rate of atrial fibrillation,with a total of 582 cases,showing little inter-study heterogeneity.The morbidity of heart failure was reported in6 studies,with a total of 582 cases.5 studies reported the mortality during hospitalization,with a total of 484 cases,showing little inter-study heterogeneity.Changes in serum C-reactive protein(CRP)before and after treatment were reported in 2 studies.SMD of serum CRP levels at different points in time were calculated for Meta-analysis,showing a noticeable heterogeneity,then subgroup analysis and Meta regression analysis were performed to analyse the sources of heterogeneity.3 studies reported changes of ventricular heart rate(Ventricular Heart Rate,VHR).SMD of VHR at different time points were calculated for Meta-analysis.Results show little heterogeneity between studies.2 studies reported the rate of adverse effects of treatment,with a total of cases 204 cases,RR was calculated for Meta-analysis,showing little heterogeneity between studies.In addition,another paper reported the plasma NT-proBNP(N-terminal pro b-type natriuretic peptide),BNP(b-type natriuretic/brain natriuretic peptide),CA199(carcino-embryonic antigen-199),and AFP(alpha fetoprotein),LVEF,left ventricular ejection fraction),CO(Cardiac Output,),LVEDD(left ventricular end-diastolic diameter),LVESD(left ventricular end-systolic diameter).In the treatment of acute myocardial infarction complicated with atrial fibrillation,comparing the sole use of anti-arrhythmia drugs,the combimed treatment of danshen extracts based injections and anti-arrhythmia drugs shows a great advantage.The combined treatment can significantly improve the success rate of converting atrial fibrillation.It can also reduce the atrial fibrillation recurrence rate,mortality of heart failure in hospital and adverse reaction rate in the treatment process.VHRs of different time points in the treatment process can be significantly controlled as well.The difference between the outcome indicators of intervention group and the control group are statistically significant.In terms of the reduction of serum CRP,the combined treatment had more advantages,but the Meta-analysis showed that more high-quality studies and more cases were needed to confirm the advantages.Conclusion:1.Compared with routine treatment of anti-arrhythmia drugs,danshen injection can improve the clinical efficacy of myocardial infarction complicated with atrial fibrillation.The recurrence rate of atrial fibrillation in early stage of acute myocardial infarction treated with danshen based injections and anti-arrhythmic drugs was positively correlated with aging.2.From the related studies,the safety of danshen injections varies.It has been reported that there were serious adverse reactions.Meta-analysis also shows that more high-quality studies are required to evaluate the safety of danshen injections combining amiodarone for the treatment of acute myocardial infarction complicated with atrial fibrillation.It also suggests that clinical use of such treatment should be cautiously applied and given monitoring.3.Under the guidance of Chinese medicine theory,the combined use of danshen injection and anti-arrhythmia drugs represented by amiodarone can provide a better treatment for myocardial infarction complicated with atrial fibrillation. |
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