A systematic review and meta-analysis of Dengzhanxixin injection for coronary heart disease with angina pectoris patients

Background:Dengzhanxixin Injection(DZXXI)has been widely used to treat Coronary heart disease with angina pectoris patients.Therefore,the study aimed to evaluate the therapeutic efficacy and safety of DZXXI in treating Coronary heart disease with angina pectoris.Methods:The Cochrane Library,the China National Knowledge Infrastructure database,the Wanfang database,the VIP database,the PubMed database,the Medline database,the EMBASE database,and Clinical Trial were used to search literatures up to August 2022.Results:The results showed that DZXXI combined with conventional therapy were significant in clinical efficacy(relative risk(RR)=1.23,95%cerebral infarction(CI):1.18,1.29;P<0.01)and electrocardiogram curative effect(RR=1.35,95%CI:1.24-1.47;P<0.01),even the subgroup of the DZXXI≤20 ml showed the largest difference.In addition,DZXXI combined with conventional therapy could lower the level of triacylglycerol(mean difference(MD)=−0.63,95%CI:−0.72,−0.55;P<0.01),total cholesterol(MD=−1.18,95%CI:−1.28,−1.09;P<0.01)and low density lipoprotein-cholesterol(MD=−0.98,95%CI:−1.08,−0.88;P<0.01),improve the level of high density lipoprotein-cholesterol(MD=0.41,95%CI:0.33,0.49;P<0.01),blood viscosity(MD=−1.09,95%CI:−1.32,−1.86,P<0.01),plasma viscosity(MD=−0.11,95%CI:−0.11,−0.11,P<0.01)and fibrin(MD=−1.50,95%CI:−1.53,−1.47,P<0.01).Conclusion:These findings revealed that there was more efficacious in DZXXI combined with conventional therapy than that in conventional therapy for the Coronary heart disease with angina pectoris and low dose of DZXXI might be suggested.

A Clinical Study of Safflower Yellow Injection in Treating Coronary Heart Disease Angina Pectoris with Xin-Blood Stagnation Syndrome

Objective： To evaluate the clinical effect and safety of Safflower Yellow injection （SYI） in treating coronary heart disease angina pectoris （OHD-AP） with Xin-blood stagnation syndrome （XBSS）. Methods： Adopted was the multi-centered, randomized, positive parallel controlled method, 448 patients with CHD-AP-XBSS were enrolled and divided into two groups, 336 in the tested group treated with SYI and 112 in the control group treated with Salvia injection by intravenous dripping once a day for 14 days, so as to observe the conditions of angina, electrocardiogram, and therapeutic effect on traditinal Chinese medicine （TCM） symptoms as well as the safety of the treatment. Results： The significantly effective rate and total effective rate in the tested group were 60.06% （194/323） and 91.02 % （294/323） respectively; those in improvement of TOM symptoms were 40. 18% （129/321） and 75.23% （243/323） respectively, which were better than those in the control group （P〈0.01）. Conclusion： SYI Injection is effective and safe in treating OHD-AP-XBSS.

Clinical Non-inferiority Trial on Treatment of Coronary Heart Disease Angina Pectoris of Xin-blood Stasis Syndrome Type with Lyophilized Salvia Salt of Lithospermic Acid Powder for Injection

Objective： To evaluate the effectiveness and safety of lyophilized Salvia salt of lithospermic acid powder for injection （SSLA） in treating coronary heart diseases angina pectoris （CHD-AP） of Xin-blood stasis syndrome type, and to conduct the non-inferiority trial with Danshen injection （丹参注射液, DSI） as positive control. Methods： An non-inferiority clinical layered, segmented, randomized, and blinded trial on three parallel and multiple centered groups was conducted in 480 patients with stable effort angina grade Ⅰ , Ⅱand Ⅲ, who had two or more times of attack every week. The 240 patients in test group A were treated with SSLA 200 mg added in 250 ml of 5% glucose solution for intravenous dripping every day; the 120 patients in test group B were treated with SSLA but the dosage doubled; and the 120 patients in the control group were treated with DSI 20 ml daily in the same method as SSLA was given. The clinical effectiveness and safety were evaluated after the patients were treated for 14 days. Results： The results showed that the markedly effective rate in test groups A, B and control group was 37.45 %, 36.75 % and 30.09 % respectively, while the total effective rate in them was 88.09%, 89.74% and 67.26% respectively. Statistical significance was shown in comparisons of the therapeutic effect between control group with test group A and test group B, with that in the two test groups superior to that in the control group, and non-inferiority trial showed eligibility （P〈0.01）. Adverse reaction appeared in 8 patients in the test groups and 2 in the control group. Conclusion： SSLA has definite therapeutic effect in treating patients with CHD-AP, with its effect not inferior to that of DSI, and no evident toxic-adverse reaction.

Effects of adjuvant Chinese patent medicine therapy on major adverse cardiovascular events in patients with coronary heart disease angina pectoris:a population-based retrospective cohort study

Objective: This study aimed to explore the effects of Chinese patent medicine(CPM) in reducing the incidence of major adverse cardiovascular events(MACE) in patients with coronary heart disease(CHD) angina pectoris and improving clinical effectiveness and provide evidence for its use as clinical adjuvant therapy.Methods: Twenty-eight thousand five hundred and seventeen patients hospitalized with CHD angina pectoris from 6 hospitals were divided into CPM group(n = 11,374) and non-CPM group(n = 17,143) to evaluate the incidence of MACE, including myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.Results: The incidence of MACE in the CPM group was lower than that in the non-CPM group. CPM therapy was an independent protective factor that reduced the overall risk of MACE [adjusted hazard ratio = 0.40, 95% confidence interval(0.33;0.49)]. Patients in the CPM group who received one, two, or three types of CPM could benefit from adjuvant treatment with CPM, and taking more types of CPM was associated with a lower risk of MACE. In addition, the male population was better than the female population at taking CPM, and middle-aged people aged 55 to 64 were more suited to take CPM based on Western medicine.Conclusions: The use of CPM as adjuvant therapy can decrease the occurrence of MACE in patients with CHD angina pectoris,especially in men and middle-aged people, and the drug treatment plan should be optimized accordingly. However, this conclusion needs further verification by prospective cohort studies in the future.

Network-meta analysis of 9 kinds of patent Chinese medicine for nourishing qi and activating blood in the treatment of angina pectoris of coronary heart disease

Objective:To evaluate the efficacy and safety of Yiqi Huoxue oral Chinese patent medicine in the treatment of angina pectoris.Methods:the databases of EMBASE,PubMed,CNKI,Wanfang and VIP were searched by computer,and the randomized controlled trial(RCT)of Yiqi Huoxue Chinese patent medicine in the treatment of angina pectoris of coronary heart disease(CHD)was searched until December 2019.By using stata15.1 software,the total clinical effective rate,the improvement rate of ECG,the improvement rate of angina pectoris,the attack frequency and duration of angina pectoris were taken as the outcome indicators for network meta analysis and mapping.Results:51 RCTs were included,including 9 kinds of traditional Chinese medicine.The results of network meta analysis showed that:in terms of clinical total effective rate,the order was Shexiang Baoxin Pill(78.2%)>xueshuanxinming tablet>Dengzhan Shengmai capsule>Shengui Capsule>Tongxinluo capsule>Tongmai Yangxin pill>Yangxin tablet>Shexiang Tongxin drop pill>Naoxintong capsule;the improvement of ECG was Tongmai Yangxin pill(85.2%)>Yangxin tablet>Dengzhan Shengmai capsule>Shexiang Tongxin drop pill>Shexiang Baoxin Pill>Tongxinluo gum Capsule>Shengui Capsule>Naoxintong capsule;in order to reduce the frequency and duration of angina pectoris,they are conventional Naoxintong capsule(88.6%)>Shengui Capsule>Tongmai Yangxin pill>Shexiang Baoxin Pill>xueshuanxinmingpian>Tongxinluo capsule>Shexiang Tongxin drop pill>Dengzhan Shengmai capsule;Shexiang Baoxin Pill(66.9%)>Dengzhan Shengmai capsule>Shexiang Tongxin drop pill>Tongxinluo capsule>xueshuanxinmingning capsule Tablet>Tongmai Yangxin pill.Conclusion:Traditional Chinese medicine combined with western medicine has obvious advantages in the treatment of angina pectoris.Shexiang Baoxin Pill,Dengzhan Shengmai capsule and Tongmai Yangxin pill can be given priority.

Sixty-one Cases of Angina Pectoris due to Coronary Heart Disease Treated by External Use of the Paste of Nitrum and Realgar Powder on Zhiyang(GV 9)

In order to inquire into the therapeutic effects of Xiao Shi Xiong Huang San (硝石雄黄散the Nitrum and Realgar Powder), one of the Dunhuang Prescription, on angina pectoris due to coronary heart disease (APCHD), the authors have treated 61 cases of APCHD by externally applying paste of the powder on Zhiyang (GV 9), with another 30 cases of APCHD treated with the nitroglycerin paste on Zhiyang as the controls. The results showed that the total effective rate was 82% and markedly effective rate 31.2% in the treatment group (the Paste of Nitrum and Realgar Powder), and the total effective rate was 46.6% and markedly effective rate 23.2% in the control group (the nitroglycerin paste). The difference in therapeutic effects between the two groups was very significant (P<0.01), indicating that the therapeutic effect of the former was significantly superior to that of the latter.

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or diastolic dysfunction (48%). 43 percent of the patients with mixed angina had systolic dysfunction and other 43 percent of them had normal cardiac function. However, patients with accelerated effort angina (AEA) were characterized by diastolic dysfunction (31%) or normal heart function (60%). ② In hemodynamic examination, the pulmonary capillary wedge pressure of positive patients rose, at the same time cardiac index fell to the extreme instantaneously after loading in volume-loading test and then they restored to the basic level until 60 minutes. However, both PCWP and CI of the negative patients reach the peak momentarily after loading. They returned to the basic level within 30 minutes. ③ coronary arteriography show: there are 41% of patient with three-vessel disease, 50% with two-vessel disease, 9% single vessel disease and left main narrowing 22. 7% in AEA. There are separately 76%, 24%, 0% and 36% in AD; and 26.1% , 43.4% , 21.7% , 43.4% in MA. ④ Constituent ratio of the AEA and MA were separately compared with AD, AEA/AD: P < 0.05(P = 0.031); MA/AD: P < 0.01 (P = 0.000313). Conclusions Most of patients with the above three types of unstable angina pectoris suffered from the basic heart dysfunction and cardiac reserve dysfunction which might participate in the occurrence and development of unstable angina pectoris. In angiography, there are the most three-vessel diseases in AD that are, therefore, the most severe UAP.

Relationship Between Serum Creatine Kinase Isoenzyme MM Subbands and the Gradation of Coronary Stenosis in Patients with Unstable Angina Pectoris

Objective To observe the relationship between serum creatine kinase isoenzyme MM sub-bands (CKMM3/MM1 ratio) and the gradation of coronary stenosis and provide a simple, reliable, and economical method for identifying high-risk unstable angina pectoris (UAP). Mehtods Blood samples were drawn at different time after onset of chest pain in 21 patients with UAP and only once in 20 each volunteers for control. CKMM3/MM1 ratio was detected by nonserial buffer agarose gel electrophoresis. CKMB and CK were observed by velocity method. An emergent coronary arteriography was performed as soon as patients were admitted into hospital. Results Patients with UAP were divided into two subgroups: patients with elevated serum enzyme [P( + )] and patients with normal serum enzyme [P( - ) ] according to CKMM3/MM1 ratio < 0. 5. Patients with UAP( + ) had higher serum CKMM3/MM1 ratios from 0.5 to 12hrs and serum CKMB from 2 to 12 hrs than those with UAP( - ) and control ( P < 0. 05) . Serum enzyme concentrations of patients with UAP whose coronary lumen had 90% or more than 90% stenosis were significantly higher than those whose coronary lumen had less than 90% stenosis ( P <0. 01) . Any CK-MM3/MM1 ratio was less than 1. 0 and CK within the normal range in patients with UAP( + ) group. Conclusions CKMM3/MM1 ratios in patients with UAP can reflect severity of myocardial ischemia. SerumCKMM3/MM1 ratio provides a simple, reliable, and economical method for identifying high-risk UAP.

Thinking on How to Construct the System of Chinese Medicine Efficacy Evaluation for Coronary Heart Disease Angina Pectoris

The existing efficacy evaluation for coronary heart disease （CHD） angina pectoris does not demonstrate the characteristics and advantages of Chinese medicine （CM）, so a new system of efficacy evaluation which can scientifically and systematically reflect the specific features of CM needs to be urgently set up. Based on wide references of efficacy evaluations of CHD angina pectoris from our country and abroad, and considering the general acceptance by academic circles and demonstration of the characteristics of CM, this paper tries to set up a new index system of efficacy evaluation, combining both disease and syndrome differentiation for CHD angina pectoris. This paper also offers some explorations based on the results of clinical trials. The system is composed of six aspects, including efficacy evaluation of ＂disease＂, syndrome factors and main endpoints （the incidence of important clinical events）, as well as patient reported outcomes, safety evaluation and medical economics.