Network Meta-analysis Of Chinese Patent Medicine In The Treatment Of Coronary Heart Disease After PCI

Objective: The network Meta-analysis method was used to systematically evaluate the clinical efficacy and safety of different Chinese patent medicines in the treatment of coronary heart disease after PCI,and to provide evidence-based medical evidence for the selection of various Chinese patent medicines in clinical application.Methods: Pubmed,Web of science,Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang,VIP,and China Biomedical Literature Database were comprehensively retrieved.The retrieval method of Boolean logic operation was adopted,and the retrieval time was from the establishment of the database to October 1,2020 in the form of subject words and free words.Literatures on conventional DAPT combined with Chinese patent medicine recommended by expert consensus and postoperative guidelines for interventional therapy of coronary heart disease were collected.Restenosis,clinical adverse cardiovascular events,angina recurrence,blood stasis syndrome score and cardiac color doppler ultrasound after 6 months of postoperative treatment were used as outcome indicators to evaluate clinical efficacy.Stata 14.0 and R language 3.5.2 software were used for network Meta-analysis,and the data included in the literature were extracted in the form of pairwise data.Stata software package networkplot,netweight,ifplot,netfunnel were used to draw network evidence map,contribution map,inconsistency detection map and publication bias map.In the Java environment,Ge MTC 0.14.3 software is used to extract the data included in the literature,and the trajectory density map is drawn by using the iterative operation of R language,and the hierarchical probability map of the evidence map is convergent.The network Meta-analysis was performed based on the above chart results.Results: A total of 25 articles were included,a total of 5559 patients with coronary heart disease after PCI.The heterogeneity of reticular Meta-analysis showed that the incidence of ISR in the experimental group was lower than that in the control group(OR = 1.92,95 % CI : 1.58,2.34,P = 0.000).Improvement of TCM blood stasis syndrome score(SMD = 0.79,95 % CI : 0.66,0.93,P = 0.000);The incidence of MACE in trial group was lower than that in control group(OR = 2.21,95%CI : 1.8,2.27,P = 0.000).Reduce angina recurrence(OR = 3.84,95%CI: 2.88,5.12,P = 0.000);The left ventricular ejection fraction and cardiac function were improved(SMD =-0.63,95% CI:-0.81,-0.54,P=0.000),indicating that the differences were statistically significant.Through the analysis of evidence diagram,network contribution diagram and hierarchical ranking diagram after iterative analysis,it can be seen that the combination of Chinese patent medicines on the basis of DAPT recommended by the guidelines can improve the clinical benefits of patients with coronary heart disease after PCI,and the scheme is the best.In order to reduce the recurrence of angina pectoris,on the basis of DAPT scheme combined with Xiongshao capsule showed obvious advantages.For improving blood stasis syndrome integral,Xuefu Zhuyu capsule combined with DAPT is the best treatment.In terms of reducing the occurrence of postoperative ISR,Tongxinluo capsule combined with DAPT scheme has comparative advantages.The network contribution diagram showed that there was no difference in the proportion of studies included in improving left ventricular ejection fraction between direct and indirect comparisons across the Meta-analysis.Conclusion: 1.In the treatment of coronary heart disease after PCI,compared with the simple DAPT treatment,Chinese patent medicine combined with DAPT treatment can enhance the clinical efficacy;2.In the prevention and treatment of angina recurrence after PCI,DAPT combined with Xiongshao capsule may be more advantageous;For improving the blood stasis syndrome score,the clinical benefit of conventional DAPT combined with Xuefu Zhuyu capsule was the best.3.In terms of improving postoperative restenosis and preventing adverse cardiovascular events,the postoperative treatment scheme of conventional DAPT combined with Tongxinluo capsule may have more advantages.