A Meta-analysis Of Clinical Efficacy And Safty About Tongxinluo Treatment Of Coronary Artery Disease In Patients After PCI

Objective:TO evaluate the effectiveness and safety of tongxinluo for coronary heart disease after PCI by meta analysis method.And to investigate the therapeutic valuue of tongxinluo capsule after PCI in patients with coronary heart disease.The purpose of this study is provide treatment ideas and objective evidence for clinical medicine intervention in these patients.Methods:Randomized controlled trials(RCT) on treatment of coronary heart disease after PCI by Tongxinluo were retrieved from Pubmed,China Academic Journals Full-text Database(CNKI),Wanfang Med Online,Chinese Biomedical Literature Database(CMBdise) and VIP Database.(deadine for April 2014).All collected RCTs were screened, extracted data, and assesed according to the Jadad scale.Eventually incorporate standards-compliant 27 RCTS, including a total of 2399 cases of coronary heart disease in patients after PCI.After assessing the risk of bias using Revman5.2Meta-analysis software.The main index for major adverse cardiovascular events(myocardial infarction again,PCI again,coronary artery bypass,angina pectoris,ECG improvement,restenosis rate);Cardiac function(EF values, 6 min walk test);Physical indicators(vascular endothelial function, inflammatory cytokines, lipid changes).Safety index is the exit rate of drug-related side effects and reactions.Results: After rigorous screening, this study finally included 27 RCTS, a total of 2399 cases of coronary heart disease patients after PCI..Interventions in the treatment group is Tongxinluo capsule combined with conventional western medicine,and the control group is conventional western medicine.Meta-analysis of the results by the various outcomes are shown below:Major adverse cardiovascular events: After Tongxinluo capsule combined with conventional medicine after treatment, the patient’s symptoms of angina and ECG effective rate of improvement than the control group [OR = 4.27,95% CI(2.85,6.40), P<0.00001], [OR = 2.42, 95% CI(1.37,4.28), P <0.00001]; Compared with the control group, the Tongxinluo capsule combined with conventional western medicine treatment can significantly reduce coronary heart disease in patients with restenosis after PCI ratio[OR = 0.24,95% CI(0.14,0.43), P <0.00001], the incidence of acute myocardial infarction [OR = 0.26,95% CI(0.11,0.63), P = 0.003], PCI incidence [OR = 0.22,95%CI(0.10,0.46), P <0.00001]. But in the two treatment regimens, the incidence of coronary artery bypass difference was not significant [OR = 0.23,95% CI(0.05,1.10), P= 0.07].Heart function: The results show Tongxinluo capsule combined with conventional western medicine treatment can significantly improve the EF value liter levels in patients [SMD = 0.99,95% CI(0.39,1.59), P = 0.001], increase 6min walk length [SMD= 0.65,95% CI(0.40,0.89), P <0.00001]. Effectively improve the patient’s heart function.Physical indicators:(1) Comparison of the vascular endothelial growth factor, the results show Tongxinluo capsule combined with conventional western medicine treatment can significantly improve patients’ FMD and NMD [SMD = 1.30,95% CI(0.74,1.85), P <0.0001], [SMD = 0.61,95% CI(0.38,0.84), P <0.00001], also changed the basis of the inner diameter of the blood vessel [SMD = 0.21,95% CI(0.01,0.40), P =0.04].(2) changes in lipids: The results show that Tongxinluo capsule combined with conventional western medicine treatment can significantly reduce levels of LDL- L[SMD =-0.86,95% CI(-1.35,-0.37), P = 0.0005], but lower triglycerides, total cholesterol and elevated the role of HDL-L is not very clear [SMD =-0.04,95% CI(-1.09,0.29), P = 0.25], [SMD =-0.93,95% CI(-2.07,0.21), P = 0.11], [SMD =0.30,95% CI(-0.12,0.72), P = 0.16].(3) Comparison of inflammatory cytokines, the results show Tongxinluo capsule combined with conventional western medicine treatment can significantly reduce ICAM-1 levels [WMD =-33.84,95% CI(-44.97,-22.71), P <0.00001], CRP levels [WMD =-2.65,95% CI(-3.35,-1.77), P <0.00001],capable of raising the level of IL-10 [WMD = 83.67,95% CI(77.52,89.82), P<0.00001].Conclusions: According to the literature included 27 by Meta analysis confirmed Tongxinluo treatment of angina after PCI in patients with conventional western medicine plus basis, can significantly reduce the occurrence of adverse cardiovascular events after PCI in patients with lower levels of inflammation and improve endothelial function, can improve the quality of life of patients and actively improve prognosis. And compared with the control group, the Tongxinluo not increase adverse reactions, clinical application is more secure.