A multicentre randomized clinical trial on efficacy and safety of huxin formula in patients undergoing percutaneous coronary intervention

Complement use of Chinese herbal medicine after percutaneous coronary intervention: a prospective observational study

BACKGROUND

Chinese herbal medicine is widely used as a complement or alternative treatment in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in China. We compared the incidence of the major adverse cardiovascular event (MACE) of CAD patients with or without the complement use of Chinese herbal medicine after PCI.

METHODS

In this prospective, observational study that was conducted from September 2016 to August 2019 in Fuwai Hospital (China), we followed up consecutive patients who received PCI treatment for two years. MACE was defined as the composite all-cause mortality, revascularization, and myocardial infarction (MI) and was compared between those using (integrative medicine group) or those not using Chinese herbal medicine as an additional treatment to standard Western medicine, with unadjusted (Kaplan-Meier curves) and risk-adjusted (multivariable Cox regression) analyses.

RESULTS

A total of 5942 patients after PCI were enrolled in this study, and 5453 patients were included in the final analysis (4189 [76.8%] male; mean age: 61.9 ± 9.9% years). During the follow-ups, 2932 (53.8%) patients used only Western medicine while 2521(46.2%) patients had used Chinese herbal medicine as an additional treatment to standard Western medicine. Patients in the integrative medicine group (IM group) were older than the Western medicine group (WM group), had more females and less previous MI. The incidence of MACE was 15.3% (449/2932) in WM group and 11.54% (291/2521) in IM group. Cox regression analysis showed that cumulative incidence of MACE was 27% lower in patients of the IM group than those in WM group (hazard ratio = 0.73; 95% CI: 0.63-0.85; P < 0.0001).

CONCLUSIONS

For CAD patients after PCI treatment, complement use of Chinese herbal medicine is associated with a lower 2-year MACE incidence. Randomized prospective studies are warranted to provide higher levels of benefit evidence in these patients.

The effect of Huoxue Huayu decoction on restenosis after percutaneous coronary intervention in patients with coronary heart disease: A protocol for systematic review and meta-analysis

BACKGROUND

Percutaneous coronary intervention (PCI), as the most common treatment for coronary heart disease (CHD), has the advantages of simple operation, minimal invasion, rapid reconstruction, and vessels opening. The problem, however, is that many patients develop restenosis within 6 months after PCI. In traditional Chinese medicine (TCM), Huoxue Huayu decoction (HXHYD) is widely used to treat cardiovascular diseases, and its important role as a complementary and alternative therapy for the prevention and treatment of post-PCI restenosis in CHD patients has been extensively reported. However, controversy exists among different studies. Therefore, we collected relevant randomized controlled trials for a meta-analysis to assess the efficacy and safety of HXHYD in the prevention of post-PCI restenosis in patients with CHD.

METHODS

Randomized controlled trials of HXHYD in the prevention of post-PCI restenosis in patients with CHD will be retrieved from PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan Fang Database, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Clinical Trial Register. The 2 authors will independently conduct the literature search, literature screening, data extraction, and quality assessment. Data analysis will be performed using STATA 14.0.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide high-quality, evidence-based medical evidence for the efficacy and safety of HXHYD in the prevention of post-PCI restenosis in patients with CHD.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/PNZSM.

The effect of Huoxue Huayu decoction on restenosis after percutaneous coronary intervention in patients with coronary heart disease: A protocol for systematic review and meta-analysis

BACKGROUND

Percutaneous coronary intervention (PCI), as the most common treatment for coronary heart disease (CHD), has the advantages of simple operation, minimal invasion, rapid reconstruction, and vessels opening. The problem, however, is that many patients develop restenosis within 6 months after PCI. In traditional Chinese medicine (TCM), Huoxue Huayu decoction (HXHYD) is widely used to treat cardiovascular diseases, and its important role as a complementary and alternative therapy for the prevention and treatment of post-PCI restenosis in CHD patients has been extensively reported. However, controversy exists among different studies. Therefore, we collected relevant randomized controlled trials for a meta-analysis to assess the efficacy and safety of HXHYD in the prevention of post-PCI restenosis in patients with CHD.

METHODS

Randomized controlled trials of HXHYD in the prevention of post-PCI restenosis in patients with CHD will be retrieved from PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan Fang Database, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Clinical Trial Register. The 2 authors will independently conduct the literature search, literature screening, data extraction, and quality assessment. Data analysis will be performed using STATA 14.0.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide high-quality, evidence-based medical evidence for the efficacy and safety of HXHYD in the prevention of post-PCI restenosis in patients with CHD.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/PNZSM.

Effect of nicorandil combined with trimetazidine on miR-223-3p and NRF2 expression in patients with coronary heart disease

OBJECTIVE

The aim of this study was to explore the effect of nicorandil (NCR) combined with trimetazidine (TMZ) on miR-223-3p and NRF2 expression in patients with coronary heart disease (CHD).

METHODS

This study included 71 CHD patients admitted to our hospital from February 2017 to March 2019, including 33 cases in the control group (CG) treated with NCR and 38 cases in the research group (RG) treated with TMZ combined with NCR. Improvement in clinical efficacy after treatment was observed in the two groups; serum miR-223-3p and NRF2 levels pre- and post-treatment were compared, and the predictive value of the two for curative effect was analyzed. In addition, ST segment depression frequency and total duration, pre- and post-treatment cardiac function levels and blood lipid levels were recorded and compared.

RESULTS

RG had statistically more markedly effective cases and notably lower serum miR-223-3p and NRF2 expression than CG after treatment. Through receiver operating characteristic (ROC) curve analysis, it was found that the area under curves (AUCs) of miR-223-3p and NRF2 were 0.716 and 0.712 respectively. The post-treatment ST segment depression frequency and duration were lower in RG than in CG (P<0.05). Cardiac function and blood lipid levels were significantly better in RG as compared to those in CG after treatment (P<0.05).

CONCLUSIONS

NCR combined with TMZ is more effective in patients with CHD, and miR-223-3p and NRF2 can be predictors of clinical efficacy.

Effect and safety of Chinese patent medicine capsules for recurrent angina pectoris after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

INTRODUCTION

Recurrent angina pectoris after percutaneous coronary intervention (PCI) is a common clinical syndrome, which seriously reduces the quality of life and health of patients, increases medical costs, and causes the risk of cardiogenic death. The efficacy of various western medicine improving angina symptoms has not been fully confirmed at the moment, whereas Chinese patent medicine capsules (CPMC) have been generally used in clinical practice due to the therapeutic efficacy and safety. This study evaluates the efficacy and safety of CPMC for stable angina after PCI, designed to provide more evidence for clinical treatment.

METHODS

This protocol was based on the previous reporting items. We will search 3 English databases (PubMed, Excerpta Medica Database, and the Cochrane Library) and 3 Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and Chinese Biomedicine) until January 2020. RCTs to evaluate the efficacy and safety of CPMC for recurrent stable angina pectoris after PCI will be included. The primary outcome will be assessed by major adverse cardiovascular events and angina attack frequency. We will use the criteria provided by Cochrane risk of bias tool for quality evaluation and risk assessment, and use the Revman 5.3 for meta-analysis.

ETHICS AND DISSEMINATION

Ethical approval is not required for systematic review and meta-analysis. The results of this review will be disseminated in a peer-review journal.

PROSPERO REGISTRATION NUMBER

CRD42020164005.

Prevention of platelet aggregation and arterial thrombosis using a modified Shenzhu Guanxin Formula

OBJECTIVE

Modified Shenzhu Guanxin Formula (mSGF) has beneficial effects in coronary artery disease. Previously, we found that mSGF inhibited platelet aggregation in rats. In the present study we further investigated the antiplatelet and antithrombotic activities of mSGF in rats.

METHODS

Rats were orally administered mSGF (4.2, 8.4, or 16.8 g crude drug/kg), the adenosine 5'-diphosphate (ADP) receptor antagonist clopidogrel (7.875 mg/kg), or saline once a day for 7 days. The effects of mSGF on platelet aggregation were measured. Levels of cyclic adenosine monophosphate (cAMP) and phosphoinositide 3-kinase (PI3K) signaling were analyzed by ELISA and western blotting, respectively. The antithrombotic effect of mSGF was investigated using a FeCl3-induced carotid arterial thrombosis model and effects on bleeding time were assessed in a rat tail transection model.

RESULTS

mSGF significantly inhibited ADP-induced platelet aggregation in a dose-dependent manner, elevated cAMP levels and inhibited phosphorylation of extracellular signal-regulated kinase (ERK) and PI3K/protein kinase B (Akt). Moreover, mSGF dose-dependently inhibited thrombosis in a FeCl3-induced carotid arterial thrombus model and had a significantly smaller effect on bleeding time compared with clopidogrel.

CONCLUSIONS

mSGF represents a potent and safe antithrombotic agent whose antiplatelet activity is probably mediated through blockade of PI3K/Akt signaling and increased cAMP generation.

A traditional Chinese medicine therapy for coronary heart disease after percutaneous coronary intervention: a meta-analysis of randomized, double-blind, placebo-controlled trials

Huoxue Huayu therapy (HXHY) has been widely used to treat cardiovascular diseases in traditional Chinese medicine (TCM) such as hypertension and coronary heart disease (CHD). The present study describes a meta-analysis of a series of prospective randomized, double-blind, placebo-controlled trials conducted to evaluate the effect of HXHY on patients with CHD after percutaneous coronary intervention (PCI). The Cochrane Library, PubMed, EMBASE, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature database, and the Wanfang database were searched up until June 2018. A series of randomized controlled clinical trials were included and the subjects were patients with CHD who had undergone PCI. The experimental group was treated with HXHY therapy, and the control group was treated with placebo; meanwhile, all the patients accepted conventional Western medicine. Review Manager 5.3 software was used for the statistical analysis. Ten trials were included in the final study. The overall risk of bias assessment was low. HXHY had a greater beneficial effect on reducing the in-stent restenosis (ISR) rate (RR = 0.57, 95% confidence interval [CI] [0.40-0.80], P=0.001) and the degree of restenosis (MD = -8.89, 95% CI [-10.62 to -7.17], P<0.00001) compared with Placebo. Moreover, HXHY was determined to be more effective in improving Seattle Angina Questionnaires (SAQ) and the revascularization rate (RR = 0.54, 95% CI [0.32-0.90], P=0.02) compared with Placebo, whereas the rate of death and MI of patients treated with HXHY were no different from those treated with the placebo (P>0.05). Therefore, HXHY is an effective and safe therapy for CHD patients after PCI.