Efficacy and safety of Panax notoginseng saponin injection in the treatment of acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose: This study aimed to assess the efficacy and safety of Panax notoginseng saponin (PNS) injection, when combined with conventional treatment (CT), for acute myocardial infarction (AMI). Methods: Comprehensive searches were conducted in seven databases from inception until 28 September 2023. The search aimed to identify relevant randomized controlled trials (RCTs) focusing on PNS injection in the context of AMI. This meta-analysis adhered to the PRISMA 2020 guidelines, and its protocol was registered with PROSPERO (number: CRD42023480131). Result: Twenty RCTs involving 1,881 patients were included. The meta-analysis revealed that PNS injection, used adjunctively with CT, significantly improved treatment outcomes compared to CT alone, as evidenced by the following points: (1) enhanced total effective rate [OR = 3.09, p < 0.05]; (2) decreased incidence of major adverse cardiac events [OR = 0.32, p < 0.05]; (3) reduction in myocardial infarct size [MD = -6.53, p < 0.05]; (4) lower ST segment elevation amplitude [MD = -0.48, p < 0.05]; (5) mitigated myocardial injury as indicated by decreased levels of creatine kinase isoenzymes [MD = -11.19, p < 0.05], cardiac troponin T [MD = -3.01, p < 0.05], and cardiac troponin I [MD = -10.72, p < 0.05]; (6) enhanced cardiac function, reflected in improved brain natriuretic peptide [MD = -91.57, p < 0.05], left ventricular ejection fraction [MD = 5.91, p < 0.05], left ventricular end-diastolic dimension [MD = -3.08, p < 0.05], and cardiac output [MD = 0.53, p < 0.05]; (7) reduced inflammatory response, as shown by lower levels of C-reactive protein [MD = -2.99, p < 0.05], tumor necrosis factor-α [MD = -6.47, p < 0.05], interleukin-6 [MD = -24.46, p < 0.05], and pentraxin-3 [MD = -2.26, p < 0.05]; (8) improved vascular endothelial function, demonstrated by decreased endothelin-1 [MD = -20.56, p < 0.05] and increased nitric oxide [MD = 1.33, p < 0.05]; (9) alleviated oxidative stress, evidenced by increased superoxide dismutase levels [MD = 25.84, p < 0.05]; (10) no significant difference in adverse events [OR = 1.00, p = 1.00]. Conclusion: This study highlighted the efficacy and safety of adjunctive PNS injections in enhancing AMI patient outcomes beyond CT alone. Future RCTs need to solidify these findings through rigorous methods. Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO/), identifier (CRD42023480131).

Keywords: Panax notoginseng saponins; acute myocardial infarction; meta-analysis; randomized controlled trials; systematic review.

FIGURE 1

Chemical structures of the main saponins in PNS. (A) 20(S)-protopanaxatriol saponins, including notoginsenoside R1, ginsenoside Rg1, and Re, and (B) 20(S)- protopanaxadiol saponins, including ginsenoside Rb1 and Rd.

FIGURE 2

Flow chart of study selection and identification.

FIGURE 3

Risk of bias of included studies.

FIGURE 4

Forest plot of total effective rate.

FIGURE 5

Forest plot of MACEs.

FIGURE 6

Forest plot of MIS.

FIGURE 7

Forest plot of ST segment elevation amplitude.

FIGURE 8

Forest plot of myocardial injury [(A) CK-MB; (B) cTnt; (C) cTnI].

FIGURE 9

Forest plot of cardiac function [(A) BNP; (B) LVEF; (C) LVEDD; (D) CO].

FIGURE 10

Forest plot of inflammatory response [(A) CRP; (B) TNF--α; (C) IL-6; (D) PTX-3].

FIGURE 11

Forest plot of vascular endothelial function [(A) ET-1; (B) NO].

FIGURE 12

Forest plot of SOD.

FIGURE 13

Forest plot of adverse events.

FIGURE 14

Subgroup analysis stratified by the reperfusion strategies [(A) total effective rate; (B) MACEs].

FIGURE 15

Subgroup analysis stratified by the courses of PNS injection [(A) total effective rate; (B) MACEs].

FIGURE 16

Subgroup analysis stratified by the initial time [(A) MACEs; (B) LVEF].

FIGURE 17

Subgroup analysis stratified by the follow-up time.

FIGURE 18

The publication bias of LVEF.