Effect of Chinese Medicine on No or Slow Reflow after Percutaneous Coronary Intervention in Myocardial Infarction Patients: A Systematic Review and Meta-Analysis

Objective:To systematic review the effect of Chinese medicine(CM)on no or slow reflow after percutaneous coronary intervention(PCI)in myocardial infarction(MI)patients.Methods:The Pub Med,EMBASE databases,Cochrane Central Register of Controlled Trials(CENTRAL),Web of Science,China National Knowledge Infrastructure(CNKI),Chinese BioMedical Literature Database(CBM),Wanfang Knowledge Service Platform(Wanfang Database)and Chinese Scientific Journal Database(VIP)were searched up to December 2017.Randomized controlled trials(RCTs)which evaluated the effect of CM therapies on no or slow reflow after PCI in MI patients were included.The primary outcome was the effect of reperfusion.Secondary outcomes were left ventricular ejection fraction,incidence of major adverse cardiovascular events and adverse effect.Results:Ten RCTs covering 814 patients were included.Two studies revealed that the incidence of no or slow reflow was less in Shenmai Injection(参麦注射液)group than in the control group measured by thrombolysis in myocardial infarction(TIMI)2(risk ratio=0.55,95%confidence interval 0.38 to 0.81,P=0.003,I^2=37%).Two studies indicated that Salvianolate Injection showed no additional benefit on no or slow reflow measured by corrected TIMI frame count compared with the conventional treatment(mean difference–4.24,95% confidence interval–13.03 to 4.54,P=0.34,I^2=86%).In addition,Tongxinluo Capsules(通心络胶囊),Danhong Injection(丹红注射液)and Xuesaitong Injection(血塞通注射液)may have the potential to reduce no or slow reflow measured during or after PCI in individual studies.Conclusions:Current evidence from RCTs are not sufficient to evaluate the effect of CM adjuvant therapies on no or slow reflow after PCI for MI patients.The included studies are limited by small sample size and unclear baseline conditions.Further rigorously designed researches and verification studies with sufficient number of patients are warranted.

Intensive cholesterol lowering with statin improves the outcomes of percutaneous coronary intervention in patients with acute coronary syndrome

Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention （PCI）. This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.Methods Altogether 228 patients with acute coronary syndrome （ACS） were randomly assigned to standard statin group （SS group, n=115） and intensive statin group （IS group, n=-113）. Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the intervened vessel were recorded before and after stent deployment. Creatine kinase （CK） isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein （hs-CRP）, P-selectin and intercellular adhesion molecule （ICAM） were measured before and 24 hours after the procedure.Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group （all P〈0.05）. Patients with no reflow phenomenon were less in the IS group （P〈0.001）. The CTFC was lower in the IS group than in the SS group （P 〈0.001）. TMPG was also improved in the IS group than in the SS group （P=0.001）. Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group （18.74±8.41 vs 21.78±10.64, P=0.018）. Similar changes were also found in troponin I （0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006）. CK-MB elevation occurred in 27.8% （32/115） of the patients in the SS group vs 15.9% （18/113） in the IS group （P=-0.030）. Myocardial necrosis was detected in 4.4% （5/115） of the patients in the SS group, whereas 0.9% （1/113） in the IS group （P=0.341）. But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group （36.5%, 42/115） than in the IS group （19.5%, 22/113） （P=0.04）. Among them, myocardial necrosis was detected in 13.0% （15/115） of the patients in the SS group, while 4.4% （5/113） in the IS group （P=-0.021）. Myocardial infarction was found in 4.4% （5/115） of the patients in the SS group and 0.9% （1/113） in the IS group （P=0.213）.Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.