Study On Tongxinluo Capsules In The Treatment Of Acute Myocardial Infarction-Reperfusion Injury Based On Meta-Analysis

Objective: To evaluate the efficacy and safety of the Chinese patent medicine Tongxinluo Capsules in the treatment of patients after acute myocardial infarction-reperfusion therapy by Meta-analysis,and to explore the therapeutic value of Tongxinluo Capsules in patients after acute myocardial infarctionreperfusion therapy,to provide treatment ideas and objective evidence for clinical TCM intervention and treatment of such patients.Methods: Search Pub Med,Cochrane,Embase,Clinical Trials.gov,Web of Science,American Center for Clinical Trials,CNKI,Wanfang Database,VIP Chinese Science and Technology Journal Database,and China Biomedical Literature Database by computer(the deadline is 2022 All literatures about Tongxinluo Capsules in the treatment of patients after acute myocardial infarction reperfusion therapy in October 2009 were screened,data extracted,and evaluated by Jadad scale for all collected randomized controlled trials(RCTs).In the end,20 randomized controlled trials met the inclusion criteria,including a total of 2020 patients with acute myocardial infarction after reperfusion therapy.Rve Man5.4 was used to draw the risk bias map and bias summary map,and Stata15.0 software was used for Meta analysis.Express count data as odds ratio(odds ratio,OR)and its 95% confidence interval(CI);express as mean difference(MD)or standardized mean difference(standardized mean difference,SMD)and its 95% CI Measurement data.Stata 15.0 was used for sensitivity analysis and risk of bias assessment,and publication bias was evaluated by inverted funnel plot and Egger’s and Begger’s tests;two-tailed P<0.05 indicated statistically significant differences.The main indicators are clinical total effective rate,left ventricular end diastolic diameter,left ventricular end systolic diameter,left ventricular ejection fraction,angina pectoris,stent stenosis,heart failure,target vessel reconstruction,adverse reactions,troponin,CK-MB,TCM syndrome score;the intervention treatment group was Tongxinluo capsule combined with conventional western medicine treatment,and the control group was treated with conventional western medicine.The results of Meta-analysis for each outcome index are shown as follows:Results: Tongxinluo Capsules combined with conventional western medicine treatment reduced the number of angina pectoris [OR=0.35,95%CI(0.20,0.61),Z=3.67,P=0];reduced the incidence of in-stent restenosis [OR=0.47,95%CI(0.14,1.64),Z=1.19,P=0.24];reduce the incidence of heart failure [OR=0.36,95%CI(0.20,0.67),Z=3.22,P=0.001];reduce the incidence of target vessel remodeling [OR=0.24,95%CI(0.07,0.88),Z=2.16,P=0.03];reduce adverse reactions [OR=1.29,95%CI(0.76,2.18),Z=0.95,P=0.35];improve TCM symptom score [SMD=-2.14,95%CI(-3.45,-0.84),Z=3.22,P=0.001];in terms of improving ventricular remodeling,Tongxinluo Capsules combined with conventional western medicine can increase LVEF value [SMD= 0.83,95%CI(0.71,0.95),Z=13.99,P=0],cardiac function was effectively improved.Myocardial injury markers:(1)Meta-analysis results showed that Tongxinluo Capsules combined with conventional western medicine could significantly reduce troponin in patients [SMD=-2.19,95%CI(-4.0,-0.40),Z=2.41,P=0.02],CK-MB[SMD=-1.34,95%CI(-0.56,-2.12),Z=3.36,P =0.001],the difference was statistically significant.However,because the included studies involved few key endpoints,the risk of bias was high,and the sample size was small,the evidence quality of the combined results was not high,and the clinical value was limited.Subgroup analysis was performed on the total clinical effective rate,and the results of 2 meta-analyses suggested that the aspirin+clopidogrel group [OR=2.31,95%CI(0.75,7.08),P=0.14,Z=1.46;heterogeneity test P= 0.09,I2=65%],the results of 3 meta-analyses suggested the efficacy of Tongxinluo Capsules combined with aspirin+clopidogrel+atorvastatin [OR=5.42,95%CI(1.98,14.86),P=0.001;Heterogeneity test P=0.75,I2=0%],2 meta-analysis results suggest the efficacy of Tongxinluo Capsules combined with ticagrelor treatment group [OR=4.19,95%CI(1.60,10.95),P=0.004,Z=2.92;heterogeneity test P=0.89,I2=0%],the results of 2 meta-analyses suggested that the efficacy of Tongxinluo Capsules combined with other drug treatment groups [OR=1.41,95%CI(0.30,6.62),P=0.67,Z=0.43;heterogeneity test P=0.02,I2=82%].The LVEDD value was subgroup analyzed,and the results of 3 Meta-analyses suggested that Tongxinluo Capsules combined with aspirin + clopidogrel had a better effect[SMD =-5.00,95%CI(-5.80,-4.20),P<0.0001,Z= 12.21;heterogeneity test P=0.52,I2=0%],the results of 3 meta-analyses suggest the efficacy of Tongxinluo Capsules combined with aspirin+clopidogrel+atorvastatin group[SMD =-3.30,95%CI(-4.40,-2.21),P<0.0001,Z=5.91;heterogeneity test P=0.54,I2=0%],4 meta-analysis results suggest that Tongxinluo Capsules combined with other drug treatment groups [SMD =-4.16,95% CI(-4.88,-3.44),P<0.0001,Z=9.73;heterogeneity test P=0.89,I2=0%].Subgroup analysis was performed on the LVESD value,and the results of 3 Meta-analyses suggested that Tongxinluo Capsules combined with aspirin + clopidogrel had a better effect [SMD =-4.46,95%CI(-5.33,-3.59),P < 0.0001,Z= 12.58;heterogeneity test P=0.41,I2=0%],the results of 2 meta-analyses suggest the efficacy of Tongxinluo Capsules combined with aspirin+clopidogrel+atorvastatin group [SMD =-2.66,95%CI(-4.25,-1.07),P=0.001,Z=3.28;heterogeneity test P=0.22,I2=33%],the results of 3 Metaanalyses suggest the efficacy of Tongxinluo Capsules combined with other drug treatment groups [SMD =-4.32,95% CI(-6.72,-1.93),P=0.0004,Z=1.89;heterogeneity test P=0.0001,I2=89%].Conclusion: According to the final 20 included literatures,the Meta-analysis method confirmed that the addition of Tongxinluo Capsules on the basis of conventional western medicine treatment for patients after acute myocardial infarction reperfusion therapy can significantly improve the clinical efficiency,increase LVEF value,and reduce left Echocardiographic indicators such as ventricular end-diastolic diameter and left ventricular end-systolic diameter can improve ventricular remodeling,reduce the incidence of angina pectoris,instent restenosis,heart failure,and target vessel reconstruction,reduce troponin and CK-MB levels,and improve TCM symptoms integral.And compared with the control group,Tongxinluo Capsules did not increase the adverse reactions of patients,and the clinical application is relatively safe.