| Summary: | Background Coronary artery disease (CAD) is also known as coronary heart disease and ischemic heart disease. The pathogenesis of CAD stems from the narrowing (stenosis) of the coronary arteries as a result of deposition of atherosclerotic plaque, which results in an insufficient supply of oxygen to the heart muscles. A critical reduction of the blood supply to the heart may result in myocardial infarction (MI). Chinese herbal medicine is widely used in both inpatient hospital care in China and the use of CHM for treating MI is widely adopted. However, there is a knowledge gap to clearly establish evidence that CHM is effective in improving the outcomes of MI patients. A systematic review of RCTs on the efficacy and safety of CHM for MI is thus worth performing. Study Objectives 1) To assess the effectiveness of CHM therapies with a focus on preventing attack of angina and MI in symptomatic cardiovascular diseases (CVD) (e.g. angina) and asymptomatic CAD (by imaging). If the number is manageable, we will also examine the effect of CHM therapies on reducing mortality and re-infarction in those with acute MI (AMI); 2) To explore whether there are some CHM therapies that are more effective than others (This analysis will depend on the number of trials available); 3) To explore in what AMI patients by Chinese Medicine syndrome CHM will be more effective (This analysis will again depend on the number of trials available); Method Comprehensive literature search was performed in several databases, 12666 citations were retrieved and 119 studies were included in the final systematic review. Twenty two trails were included in the systematic review to explore the treatment effect of the combination of CHM with WM on AMI patients. As for SA patients, UA patients, SA & UA patients and patients after cardiac surgery the included number of studies were 9, 31, 6 and 10, respectively. Results For AMI patients, the combination of CHM with WM could significantly reduce the occurrence of total death rate (RR = 0.59, 95%CI 0.52-0.68; p<0.001), total heart events (RR=0.51, 95%CI 0.44-0.60; p<0.001), myocardial re-infarction (RR = 0.47, 95%CI 0.38-0.59; p<0.001), heart failure (RR = 0.52, 95%CI 0.42-0.63; p<0.001), Cardiac arrhythmia (RR=0.59, 95%CI 0.48-0.73; p<0.001), cardiogenic shock (RR=0.57, 95%CI 0.43-0.76; p<0.001), angina (RR=0.47, 95%CI 0.39-0.56; p<0.001), Cardiac death (RR=0.63, 95%CI 0.52-0.76; p<0.001), Fatal myocardial re-infarction (RR=0.56, 95%CI 0.33-0.95; p=0.032) and Fatal cardiogenic shock (RR=0.67, 95%CI 0.51-0.90; p=0.008). In SA patients, the combination of CHM with WM could significantly reduce the risk of total heart events (RR=0.50, 95%CI 0.33-0.78; p=0.002), myocardial infarction (RR = 0.32 95%CI 0.14-0.72, p=0.006), heart failure (RR=0.37, 95%CI 0.15-0.91; p=0.031), cardiac arrhythmia (RR=0.27, 95%CI 0.13-0.57; p=0.001) and angina (RR=0.46, 95% CI 0.30-0.71; p<0.001). For patients with UA, the combination of CHM with WM significantly reduced the incidence of total heart events (RR =0.46 95%CI 0.32-0.66, p<0.001), myocardial infarction (RR = 0.37 95%CI 0.26-0.54, p<0.001), heart failure (RR=0.37, 95%CI 0.15-0.91; p=0.031), cardiac arrhythmia (RR=0.27, 95%CI 0.13-0.57; p=0.001) and angina (RR=0.46, 95%CI 0.30-0.71; p<0.001). In SA and UA patients, the combination of CHM with WM significantly reduced the incidence of myocardial infraction (RR = 0.34, 95%CI 0.17-0.68; p=0.002) and angina (RR = 0.46, 95%CI 0.30-0.70; p<0.001). The combination of CHM with WM significantly reduced the risk of total heart events (RR = 0.33 95%CI: 0.23-0.48; P = 0.000), myocardial infraction (RR = 0.18 95%CI: 0.06-0.56; P = 0.003) and percutaneous coronary intervention events (RR = 0.39 95%CI: 0.23-0.66; P < 0.001) in Patients after cardiac surgery. Conclusions Our meta-analysis results suggest that the combination of CHM with WM could bring better outcomes to CAD patients and CAD patients would get more benefit from the treatment of the combination of CHM with WM than treated with WM alone. |