Unstable angina: prognosis of the individual patient

Herbal medicine (zhishi xiebai guizhi decoction) for unstable angina: Protocol for a systematic review and meta-analysis

BACKGROUND

Unstable angina (UA) is a clinically common coronary heart disease. Zhishi xiebai guizhi decoction (ZXGD) has been widely used in the management of UA, although its effective evidence is not clear and there is no systematic review regarding its efficacy and safety. Therefore, we conduct this systematic review protocol to evaluate the efficacy and safety of ZXGD in the treatment of UA.

METHODS

We will search the following electronic databases: Cochrane Library, Web of Science, PubMed, EBASE, Springer, WHO International Clinical Trial Registration Platform, China Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP), and Wan-fang database from their inception to October 2018. Only randomized controlled trials (RCTs) published in English and Chinese will be included. Continuous data will be expressed as mean difference or standard mean difference, and dichotomous data relative as risk. Study selection, data extraction, and assessment with risk of bias and data analysis will be performed by two independent authors. RevMan software version 5.3 will be used for meta-analysis.

RESULTS

This study will provide high-quality evidence of ZXGD in the treatment of UA from the following aspects, including clinical efficacy, blood lipids, Seattle angina scale, electrocardiogram improvement, ST-segment depression, left ventricular ejection fraction, angina duration, and adverse events.

CONCLUSION

This systematic review will provide a basis for judging whether ZXGD is an effective intervention for UA or not.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD 42018115528.

Guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction: proposed revisions. International Cardiology Forum

BACKGROUND

In 1994, the United States Agency for Health Care Policy and Research issued clinical practice guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction. In the past 5 years, rapid progress has been made in the management of patients with unstable coronary syndromes, yet current guidelines do not necessarily reflect these advances.

METHODS AND RESULTS

An international forum of cardiology investigators reviewed existing guidelines and discussed areas in which the diagnosis and treatment of unstable angina and non-Q-wave myocardial infarction should be modified. It was agreed that there is sufficient evidence to recommend the following changes: (1) use of serum cardiac markers should be expanded to include troponin I and T levels as diagnostic and prognostic tools; (2) low-molecular-weight heparins should replace unfractionated heparin as antithrombotic agents; (3) new classes of antiplatelet agents are recommended in addition to aspirin; and (4) the use of cholesterol-lowering drugs is appropriate in the long-term management of these patients.

CONCLUSIONS

Evidence from clinical trials within the last 5 years requires that significant changes be made to existing guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction. The recommendations detailed should be considered in the creation and implementation of updated guidelines.