加载口服中成药对PCI术后长期主要不良心脑血管事件影响的Meta分析

Meta-analysis of Effects of Oral Administration of Chinese Patent Medicine on Major Adverse Cardiovascular and Cerebrovascular Events after PCI

目的系统评价加载口服中成药对经皮冠状动脉介入治疗(PCI)术后长期(6个月及以上)主要不良心脑血管事件的影响。方法检索EMBASE、MEDLINE、Cochrane library、中国知网、中国生物医学文献数据库等11个数据库,纳入关于中成药对PCI术后终点事件影响的随机对照试验。运用Rev Man 5.3和STATA 12.0软件进行meta分析。结果纳入29项研究,共计4684例患者。PCI术后,与单纯常规西药治疗相比,加载口服中成药在主要终点事件[RR=0.44,95%CI(0.32,0.62),P<0.00001]、心源性死亡[RR=0.34,95%CI(0.15,0.74),P=0.007]、非致死性心肌梗死[RR=0.37,95%CI(0.24,0.58),P<0.0001]、再次血运重建[RR=0.43,95%CI(0.31,0.58),P<0.00001]、脑卒中[RR=0.50,95%CI(0.29,0.87),P=0.01]、因冠心病再住院[RR=0.59,95%CI(0.46,0.75),P<0.0001]、心力衰竭率[RR=0.30,95%CI(0.15,0.58),P=0.0003]方面具有远期疗效优势。结论西医常规治疗基础上加口服中成药,可能降低PCI术后冠心病患者长期主要不良心脑血管事件发生率。

Objective To systematically review the efficacy of routine western medicine（ RWM） plus Chinese oral patent medicines for major adverse cardiovascular and cerebrovascular events（ MACCE） during 6 months or longer after percutaneous coronary intervention（ PCI）. Methods Electronic databases,such as EMBase,Medline,Cochrane Library,CNKI,CBM,and other 11 relevant databases,were searched for randomized control trials that compared oral administration of Chinese patent drugs plus RWM with the same RWM（ or plus placebo） in preventing MACCE during 6 months or longer after PCI. The quality of retrieved literature was assessed by methods from Cochrane Handbook. Valid data were extracted and analyzed by meta-analysis using Rev Man5. 3 and STATA12. 0 software. Results A total of 29 trials（ 4684 patients） met the inclusion criteria and were analyzed. Meta-analysis showed that oral administration of Chinese patent drugs plus RWM could significantly reduce the number of primary endpoint（ RR = 0. 44,95% CI： 0. 32 - 0. 62,P〈0. 00001）,cardiac mortality（ RR = 0. 34,95% CI： 0. 15 -0. 74,P = 0. 007）,acute myocardial infarction（ RR = 0. 37,95% CI： 0. 24 - 0. 58,P〈0. 0001）,repeat revascularization（ RR = 0. 43,95% CI： 0. 31 - 0. 58,P〈0. 00001）,stroke（ RR = 0. 50,95% CI： 0. 29 - 0. 87,P =0. 01）,readmission for CHD（ RR = 0. 59,95% CI： 0. 46 - 0. 75,P〈0. 0001）,heart failure（ RR = 0. 30,95%CI： 0. 15 - 0. 58,P = 0. 0003）. Conclusions Oral administration of Chinese patent medicines may help prevent long-term MACCE after PCI. Caution should be exercised in drawing a definitive conclusion due to the poor methodological quality.