The Medicine For Activating Blood Circulation System To Evaluate The Efficacy Of Intervention In Coronary Heart Disease (chd)

Objective This study aims to evaluate the effects of blood-activiating and stasis-dissolving drugs on patients with coronary heart disease. Methods We searched the electronic databases (ViP, CNKi, CBM and PUBMED) in order to obtain the RCT whose patients with coronary heart disease。The experimental group treated with blood-activiating and stasis-dissolving drugs combined with conventional therapy, at the same time, The control group treated with conventional therapy。Trials could be double-blind, single-blind or no blinded。 No language restriction was used. The methodological quality of the trials was assessed by using the Jadad-scale. Meta-analysis、Subgroup analysis, sensitivity analysis and Meta-regression were Conducted by using RevMan5.1software. Results fifty-six trials and8437patients were included.Average Jadad score was3.48. In the occurrence of the levels of total cholesterol (TC)、 triglyceride(TG)、low-density lipoprotein cholesterol、(LDL-C)、Plasma viscosity、 Fibrinogen (Fib)、CD62P、CD63、GPⅡb/Ⅲa、platelet aggregation rate (PAR)、 hs-CRP/CRP、TNF-a (Tumor Necrosis Factor-a)、endothelin(ET)、vonWillebrand factor (vWF)、Matrix Metalloproteinase-9(MMP-9)、left ventricular end systolic volume(LVESV)、left ventricular end diastolic diameter(LVEDD), the experimental group is lower than control groupsP=0.0009、P<0.00001、P<0.00001、P<0.0001、 P=0.005、P<0.0001、P<0.00001、P=0.0002、P=0.002、P=0.001/P=0.003、 P=0.03、P=0.0006、P=0.0001、P=0.04、P=0.006、P=0.04), high-density lipoprotein cholesterol (HDL-C)、nitric oxide (NO)、Flow-mediated endothelium-dependent vasodilatation (FMD)、left ventricular ejection fraction (LVEF) the experimental group is-higher than control groups (P=0.002、P<0.00001、P=0.004、P=0.0001), The difference is significant. in the occurrence of angina pectoris. Heart Failure、malignant arrhythmia, the experimental group islower than control groups (P=0.009、P=0.01、P=0.007). In the occurrence of adverse reactions, the experimental group is higher than control groups (P=0.03). For unstable paitient with Percutaneous Transluminal Coronary Intervention (PCI, In the occurrence of the levels of LDL-C、Fib、APTT、CD63、 CD62P、GPⅡb/Ⅲ、MMP-9、ET、vWF, LVEDD、LVESV, the experimental group is lower than control groups (P<0.00001、P<0.00001、P<0.004、P<0.00001、P<0.00001、 P=0.02、P<0.00001、P=0.02、P<0.00001、P<0.0001、P=0.05), NO、FMD、 EFhe experimental group is higher than control groups (P<0.00001、P<0.00001、 P=0.003), In the occurrence of death、myocardial infarction、heart failure、 Vascular reconstruction the experimental group is lower than control groups (P=0.01、P=0.02、P=0.02、P=0.04), in the occurrence of adverse reactions, The difference is not significant (P=0.93); For unstable paitient without PCI, In the occurrence of the levels of TC、TG、PV、PAR、CD62P、GPⅡb/Ⅲa、hs-CRP、 vWF、LVESV, the experimental group is lower than control groups (P=0.03、P=0.03、P<0.0001、P<0.00001、P=0.02、P<0.00001、P=0.04、P<0.00001、P <0.00001), NO、EF the experimental group is higher than control groups (P<0.00001、P<0.00001), In the occurrence of death、heart failure、malignant arrhythmia the experimental group is lower than control groups (P=0.02、P=0.03、P=0.02), in the occurrence of adverse reactions, The difference is not significant (P=0.16); For stable paitient with PCI, In the occurrence of the levels of LDL-C、Fib、hs-CRP、IL-6、vWF, the experimental group is lower than control groups (P=0.003、P=0.04、P=0.003、P=0.0001、P<0.0001), In the occurrence of angina pectoris、heart failure the experimental group is lower than control groups (P=0.01、P=0.05), in the occurrence of adverse reactions, The difference is not significant (P=0.49); For stable paitient without PCI, In the occurrence of the levels of TC、TG、LDL-C、CD62P、CRP、TNF-α、MMP、vWF, the experimental group is lower than control groups (P=0.0009、P=0.0009、P<0.00001、P=0.0008、 P=0.007、P=0.02、P<0.00001、P<0.0001), in the occurrence of adverse reactions, the experimental group is higher than control groups (P=0.02); The funnel plot is asymmetry. Conclusion based on conventional therapy, Applying blood-activiating and stasis-dissolving drugs can decrease bloodlipid, suppress the activation and assembly of platelet, lower blood viscosity, decrease inflammatory reaction and have effect on plaque stabilization,improve vascellum endothelial function and heart function. However, reduce the paroxysm of chest pain, decrease the occurrence of angina pectoris、infraction、heart failure、 malignant arrhythmia. For unstable paitients or paitients treated with PCI, based on conventional therapy, applying blood-activiating and stasis-dissolving drugs can lower events. But for unstable paitients treated without PCI, it does not reduce the events and will increase the adverse reactions. More evidence is needed to support that unstable paitients treated without PCI can benefit from blood-activiating and stasis-dissolving drugs. The funnel plot is asymmetry which indicates the exiting of potential publication bias.