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. 2024 Jan 5:14:1265766.
doi: 10.3389/fphar.2023.1265766. eCollection 2023.

Comparative efficacy of different Chinese patent medicines in preventing restenosis after percutaneous coronary intervention: a systematic review and Bayesian network meta-analysis of randomized clinical trials

Jiasai Fan #  1 , Tianli Li #  2 , Fenglan Pu #  3 , Nan Guo #  4 , Jing Wang  1 , Yuqian Gao  1 , Hongbing Zhao  1 , Xian Wang  1   5 , Haiyan Zhu  1
Affiliations

Comparative efficacy of different Chinese patent medicines in preventing restenosis after percutaneous coronary intervention: a systematic review and Bayesian network meta-analysis of randomized clinical trials

Jiasai Fan et al. Front Pharmacol. .

Abstract

Background: Chinese patent medicines (CMPs) have curative effectiveness in preventing coronary restenosis. However, the relative efficacy between different CPMs has not been sufficiently investigated. Methods: Randomized clinical trials were searched from electronic databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang, SinoMed, Chinese Clinical Trial Registry, and ClinicalTrials.gov. Bayesian network meta-analysis was performed to analyze CPMs' efficacy in preventing angiographic restenosis, recurrence angina, acute myocardial infarction, and target lesion revascularization after percutaneous coronary intervention. Results: This network meta-analysis included 47 trials with 5,077 patients evaluating 11 interventions. Regarding angiographic restenosis, the efficacy of CPMs (except Xuezhikang capsule) combined with standard treatment (Std) was superior to Std alone, and Guanxin Shutong capsule plus Std reduced the risk of angiographic restenosis by 76% (relative risk 0.24, 95% confidence interval 0.11-0.45, and very low to moderate certainty of evidence), most likely the best intervention. Fufang Danshen dripping pill combined with Std showed superiority over other interventions for relieving recurrence angina, which can reduce the risk by 83% (RR 0.17, 95% CI 0.04-0.51, very low to moderate certainty of evidence) compared to Std alone. In acute myocardial infarction after percutaneous coronary intervention, compared with Std alone, Danhong injection plus Std displayed a significant effect (RR 0.11, 95% CI 0.00-0.69, very low to moderate certainty of evidence) and was the best treatment probably. Chuanxiongqin tablet plus Std was the most effective treatment for reducing target lesion revascularization by 90% (RR 0.10, 95% CI 0.00-0.60, very low to moderate certainty of evidence) compared with Std alone. Conclusion: The results indicated that CPMs combined with Std reduced the risk of coronary restenosis after percutaneous coronary intervention. However, the results should be interpreted cautiously due to significant data limitations.

Keywords: Bayesian network meta-analysis; Chinese patent medicines; efficacy; percutaneous coronary intervention; restenosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Summary of trial identification and selection. RCT, randomized controlled trial; TCM, traditional Chinese medicine.
FIGURE 2
FIGURE 2
Risk of bias summary and risk of bias graph.
FIGURE 3
FIGURE 3
Network of treatment comparisons for Bayesian network meta-analysis. (A) Outcome of angiographic restenosis; (B) outcome of recurrence angina; (C) outcome of acute myocardial infarction; and (D) outcome of target lesion revascularization. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; GXTLC, Guanxin Tongluo capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule.
FIGURE 4
FIGURE 4
Summary of results of angiographic restenosis from network meta-analysis. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; GXTLC, Guanxin Tongluo capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule.
FIGURE 5
FIGURE 5
SUCRA curve with regard to reducing angiographic restenosis. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; GXTLC, Guanxin Tongluo capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule; SUCRA, surface under the cumulative ranking.
FIGURE 6
FIGURE 6
Summary of results of recurrence angina from network meta-analysis. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule.
FIGURE 7
FIGURE 7
SUCRA curve with regard to reducing recurrence angina. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; SUCRA, surface under the cumulative ranking.
FIGURE 8
FIGURE 8
Summary of results of acute myocardial infarction from network meta-analysis. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule.
FIGURE 9
FIGURE 9
SUCRA curve with regard to reducing acute myocardial infarction after PCI. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; SUCRA, surface under the cumulative ranking.
FIGURE 10
FIGURE 10
Summary of results of target lesion revascularization from network meta-analysis. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule.
FIGURE 11
FIGURE 11
SUCRA curve with regard to reducing target lesion revascularization. CXQ, Chuanxiongqin tablet; DHI, Danhong injection; FDDP, Fufang Danshen dripping pill; GXSTC, Guanxin Shutong capsule; QYDP, Qishen Yiqi dripping pill; SBP, Shexiang Baoxin pill; Std, standard treatment; TXLC, Tongxinluo capsule; XSC, Xiongshao capsule; XZK, Xuezhikang capsule; SUCRA, surface under the cumulative ranking.
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