Tongxinluo capsules plus conventional therapy ranked first for reducing MACEs and significantly reduced LVEDD (SMD -1.01; 95% CI -1.35 to -0.66) in post-PCI patients.
Meta-Analysis (n=10,524)
Do Chinese Patent Medicines combined with conventional therapy reduce major adverse cardiovascular events in coronary heart disease patients after percutaneous coronary intervention?
Chinese Patent Medicines, particularly Tongxinluo capsules, when added to conventional therapy, may provide clinical benefits in reducing MACEs and improving cardiac parameters in post-PCI patients.
ETHNOPHARMACOLOGICAL RELEVANCE Patients with coronary heart disease (CHD) remain at high risk of major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Chinese Patent Medicines (CPMs) have demonstrated therapeutic potential as adjunctive therapies, however, direct comparative evidence regarding their effectiveness is lacking. AIM OF THE STUDY This network meta-analysis (NMA) aims to systematically evaluate and compare the clinical efficacy and safety of CPMs combined with conventional therapy (CT) in post-PCI management. MATERIALS AND METHODS A systematic literature search was performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP, and Wanfang databases up to December 24, 2024. Randomized controlled trials investigating CPMs in CHD patients following PCI were included. Methodological quality was assessed using the Cochrane Risk of Bias tool. Outcome measures included major adverse cardiovascular events (MACEs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and nitric oxide (NO) levels. NMA was implemented using STATA 16.0 and R 4.1.2. Odds ratios and standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. Model selection was guided by heterogeneity assessed using the I2 statistic. Intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA), with robustness and publication bias evaluated through sensitivity analyses and funnel plots. RESULTS A total of 84 RCTs involving 10,524 patients and eight CPMs were included. For the primary outcome (MACEs), the SUCRA ranking indicated that Tongxinluo capsules combined with conventional therapy (TXLJN + CT) was the most effective intervention, followed by Shensong Yangxin capsules plus CT (SSYXJN + CT), Shexiang Baoxin pills plus CT (SXBXW + CT), Qili Qiangxin capsules plus CT (QLQXJN + CT), Qishen Yiqi dripping pills plus CT (QSYQDW + CT), Xinyu capsules plus CT (XYJN + CT), Fufang Danshen Dripping Pills plus CT (FFDSDW + CT), and Guanxin Shutong capsules plus CT (GXSTJN + CT), while CT alone ranked last. Correspondingly, the NMA demonstrated that TXLJN + CT was associated with the greatest reduction in LVEDD (SMD -1.01, 95% CI -1.35 to -0.66) and hs-CRP levels (SMD -2.50, 95% CI -3.33 to -1.68). The most significant improvement in LVEF (SMD 1.25, 95% CI 0.85 to 1.64) and NO levels (SMD 1.02, 95% CI 0.73 to 1.29) was observed with QSYQDW+ CT. Meanwhile, SXBXW + CT showed the greatest efficacy in reducing NT-proBNP levels (SMD -3.43, 95% CI -4.68 to -2.18). CONCLUSION CPMs combined with CT may provide clinical benefits in post-PCI management. According to SUCRA rankings, TXLJN + CT ranked first in reducing MACE and in lowering LVEDD and hs-CRP levels. QSYQDW + CT ranked first in improving LVEF and NO levels, while SXBXW + CT showed the highest ranking for reducing NT-proBNP levels. However, larger-scale, high-quality RCTs are needed to validate these findings.
Wang et al. (Mon,) conducted a meta-analysis in Coronary heart disease after percutaneous coronary intervention (n=10,524). Chinese Patent Medicines (CPMs) combined with conventional therapy vs. Conventional therapy alone was evaluated on Major adverse cardiovascular events (MACEs). Tongxinluo capsules plus conventional therapy ranked first for reducing MACEs and significantly reduced LVEDD (SMD -1.01; 95% CI -1.35 to -0.66) in post-PCI patients.