Objective To assess the efficacy and safety of Dan Hong injection for patients with angina pectoris compared with compound salvia injection as the control group. Methods Databases were electronically searched from MEDLINE, EMbase, CBM, CNKI, VIP, and Wanfang Data (January, 2007 to July, 2010), and reference lists of all papers identified were also checked. Randomized controlled trials (RCTs) of the effect of Dan Hong injection on angina pectoris were identified and assessed according to the Cochrane Handbook for Systematic Reviews of Interventions and then RevMan 4.3 was used to undertake Meta analysis. Results Twenty-seven trials involving 3 030 patients were included. Meta-analysis showed that: a) Compared with compound salvia injection, Dan Hong injection was capable of significantly decreasing the angina incidence (OR=3.84, 95% CI 3.03 to 4.88, Plt;0.000 01); b) Dan Hong injection was capable of significantly improving ECG review effectiveness compared with compound salvia injection (OR=1.98, 95% CI 1.44 to 2.66, Plt;0.000 01); c) Dan Hong injection was obviously superior to compound salvia injection in improving the NST (WMD= 0.78, 95%CI 0.42 to 1.14, Plt;0.000 1) and ∑ST (WMD= 0.45, 95%CI 0.32 to 0.57, Plt;0.000 01); and d) Dan Hong injection was able to obviously improve the hemorheology index after angina pectoris; Meta-analyses of eight trials in which adverse events were reported showed that no significant difference was found between Dan Hong injection and salvia injection (OR=0.64, 95%CI 0.33 to 1.25, P=0.19). Conclusion Dan Hong injection can effectively improve the ST segment ischemia and hemorheology index after angina pectoris, significantly increase the effectiveness of electrocardiogram reviews and eventually significantly reduce the recurrence rate of angina, and appears to be much safer. Further high quality RCTs are required to provide reliable evidence on the treatment of patients with angina pectoris.
The American Heart Association and other six major associations jointly released AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain for the first report on October 28th, 2021. This guideline stresses the risk stratification and the diagnostic workup of acute chest pain, considers the cost-effectiveness of low-risk chest pain diagnosis and examination, and recommends sharing decisions with patients. This guideline mainly involves the initial evaluation of chest pain, choosing the right pathway with patient-centric algorithms for acute chest pain, and the evaluation of patients with stable chest pain. This review makes a detailed interpretation of the recommended points of the guideline through reviewing the literature.
Objective To investigate drug usage and costs of angina inpatients in Karamay Central Hospital in 2014 and to provide evidence and reference for evidence-based pharmacy study of single disease in circulation system. Methods The information of drug use and expenditure of angina inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results We included 351 angina inpatients in Karamay Central Hospital in 2014 whose average age was 69.44±10.65 years old. Fifty-one kinds of drugs were used for angina therapy. The expenditure of drugs was 122.46 yuan per person. The symptomatic treatment drugs included 11 kinds of drugs. The top 3 usage drugs were isosorbide denigrates, aspirin, nitroglycerin. The secondary prevention medicines included 35 kinds of drugs, and were prescribed for 1 953 times; the anti-hypertensive drugs were most prescribed. The Chinese patent medicine were prescribed for 69 times. The compound Danshen dripping pill was the most prescribed drug. In total expenditure, the cost of clopidogrel, atorvastatin, irofiban ranked top three. Rivaroxaban, tirofiban, low molecular weight heparin were the top 3 drugs for per-time expenditure. Conclusion The top 3 used drugs are isosorbide denigrates, aspirin, nitroglycerin for angina inpatients in Karamay Central Hospital in 2014, while the top 3 total expenditure drugs are clopidogrel, atorvastatin and irofiban.
Objective To assess the effect of Dengzhanhua Injection for angina pectoris. Methods We performed an electronic search for MEDLINE (1966 to 2004), EMBASE (1974 to 2004), The Cochrane Library (Issue 4, 2004), CBM and CNKI (1980 to 2004). We included randomized controlled trials that met the inclusion and exclusion criteria and evaluated the quality of those trials and performed the meta-analysis by RevMan 4.2.7. Results Eight trials were included involving 634 patients. However, they were of poor quality. The results of meta-analysis indicated that there were statistical difference on symptoms and electrocardiogram (ECG) improvements between Dengzhanhua and control group (Breviscarpine≥30 mg) with RR 1.26, 95%CI 1.11 to 1.44 and RR 1.30, 95%CI 1.14 to 1.49, respectively. However, Dengzhanhua Injection (Breviscarpinelt;30 mg) vs. basic therapy showed no statistical difference in either symptom improvement (RR 1.03, 95%CI was 0.90 to 1.18) or ECG improvement (RR 1.01, 95%CI 0.86 to 1.20). In addition, Dengzhanhua decreased the myocardial infarction attacks in one year following up (OR 0.06, 95%CI 0.01 to 0.29). Conclusions Little evidence shows that Dengzhanhua is superior to simple basic therapy in the symptoms and ECG improvements as an auxiliary drug. However, this systematic review can not draw a conclusion about the effectiveness of Dengzhanhua Injection compared to simple basic therapy in the treatment of angina pectoris due to the poor quantity of included trials.
Objective To evaluate the efficacy and safety of safflower yellow pigment lyophilized power amp; dripping solution in the treatment of patients with angina, by using parenteral solution of Dan-shen root extraction as control, we designed the nonferiority clinical trial phase Ⅲ. Method 784 patients with stable angina pectoris Ⅰ, Ⅱ, Ⅲ degree and occurred more than twice per week were selected. They were randomly, stratified and blindly assigned into 5 parallel groups including one control. They were treated by using safflower yellow pigment lyophilized power (SYPLP) 80 mg + 0.9% NS 250ml, intravenously guttae, daily (trial group 1); SYPLP 160 mg + 0.9% NS 250 ml, intravenously guttae, daily (trial group 2); safflower yellow pigment lyophilized dripping solution (SYPLDS) 200 ml (160 mg), intravenously guttae, daily (trial group 3); SYPLDS 100 ml (80 mg), intravenously guttae, daily (trial group 4) and parenteral solution of Dan-shen root extraction 20 ml + 0.9% NS 250 ml, intravenously guttae, daily (control group) respectively. Efficacy and safety were evaluated after 14 days of continuous treatment. Results The angina efficacy (per-protocol population, PP): The notable effective rates of trial groups 1 to 4 and control group were 53.27%，69.44%，70.09%，55.09% and 26.00% respectively, and the effective rates were 88.79%，92.59%，93.46%，89.81% and 73.00% respectively。There was significant differences between trial group 1 and 2, trial group 3 and 4. All trial groups showed significant different effect when compared with control (P＜0.05). The effect of trial group 2 was better than those of trial group 1, and trial group 3 better than trial group 4, the four trial groups better than control group. The intention-to-treat (ITT) analysis result was almost the same to PP analysis, but trial group 3 showed no significant difference to trial group 4. In trial group 2, 3 and 4, each occurred one adverse effect, while the number was 10 in control group.Conclusion SYPLP amp; SYPLDS have certain effect on angina. They are more effective than parenteral solution of Dan-shen root extraction. No toxic side effect has been found in clinic tests.
Objective To investigate the quality of randomized controlled trials (RCTs) involving Danhong Injection for angina of coronary heart disease, and to provide references for improving the quality of clinical research on Chinese medicine (CM) injection. Methods The RCTs published from 2002 to July 2010 about Danhong Injection for angina of coronary heart disease were searched. The methodological quality of the literatures was evaluated according to the methods recommended by the Cochrane Collaboration, and the reporting quality was assessed by means of the Jadad scale and the CONSORT checklist. Results A total of 104 RCTs were included. The assessment result of Jadad scale showed: nine RCTs (8.7%) scored two, 87 (83.6%) scored one, and the other 8 (7.7%) scored zero. According to the standard of CONSORT, only 1 RCT (0.96%) described the random method; no literatures explained how to execute randomization and use placebo control; 3 RCTs (2.9%) reported endpoint outcome; 1 (0.96%) RCT performed single blind; 2 (1.9%) RCTs performed double blind; 54 (51%) RCTs calculated statistic values; 5 (4.8%) RCTs reported follow-up; no RCT reported equivalent results or negative results; 74 (71.2%) RCTs reported adverse events; no RCTs conducted sample size estimation, intention-to-treat analyses and stratified analyses; no RCTs were multicenter trials; and no RCTs recorded the accreditation and the informed consent. Conclusion The quality of RCTs about Danhong Injection for angina of coronary heart disease is still low in methodological aspects such as randomization, estimation of sample size, statistic methods, reporting of follow-up and non-follow-up, and adverse reactions, which has influences on the real evaluation of the effect of Danhong Inection. It is suggested that the future RCTs on CM injection should be conducted with references of CONSORT statement, that a clinical mode of integration of disease and syndrome should be applied according to the treatment theory based on syndrome differentiation, and that more attention should be paid to the clinical observation on adverse reactions of CM injection, so as to be helpful for safe medication and patients’ right protection.
Objective To assess the effectiveness and safety of tongxinluo capsule for coronary heart disease. Methods Both the randomized controlled trials (RCTs) and quasi-RCTs of tongxinluo capsule for coronary heart disease were collected through searching on computer from the following databases, The Cochrane Library (Issue 4, 2010), PubMed (2000 to April 2010), WanFang Data (1996 to April 2010), CNKI (1994 to April 2010) and VIP (1989 to April 2010). The trials selection based on inclusion and exclusion criteria, data extraction, cross check and quality assessment were conducted by two reviewers independently, and meta-analysis was performed with RevMan 5.0 software. Results A total of 13 studies involving 1 496 participants were included. The results of meta-analyses showed that: compared with the nitrate esters group, the tongxinluo capsule group had a better curative effect on the coronary heart disease than isosorbide dinitrate (RR=0.50, 95%CI 0.36 to 0.70) and isosorbide mononitrate (RR=0.19, 95%CI 0.12 to 0.30); there was significant difference in the total curative effect between the two groups (RR=0.34, 95%CI 0.26 to 0.44, Plt;0.000 01); the tongxinluo capsule was also better in improving the ECG than isosorbide dinitrate (RR=0.55, 95%CI 0.46 to 0.66) and isosorbide mononitrate (RR=0.58, 95%CI 0.48 to 0.70); there was significant difference in the total ECG improvement between the two groups (RR=0.56, 95%CI 0.49 to 0.64, Plt;0.000 01); the tongxinluo capsule group had a lower incidence rate of adverse reaction than the nitrate esters group with a significant difference (RR=0.33, 95%CI 0.20 to 0.53, Plt;0.000 01). Conclusion The present evidence indicates that tongxinluo capsule is not inferior to isosorbide dinitrate or isosorbide mononitrate in improving the curative effect and ECG, and it has fewer adverse reactions. More well-designed and large scale multi-centered RCTs are required with longer follow-up time to confirm this conclusion.
ObjectiveTo systematically review the efficacy and safety of pericarpium trichosanthis injection combined with conventional western medicine for angina pectoris.MethodsDatabases including CBM, CNKI, WanFang Data, VIP, PubMed, The Cochrane Library and Web of Science were searched from inception to February 20th 2017 to collect randomized controlled trials (RCTs) about pericarpium trichosanthis injection combined with conventional western medicine for angina pectoris. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs involving 1 004 patients were included. The results of meta-analysis showed that: the effective rate of angina symptoms (RR=1.24, 95%CI 1.15 to 1.33, P<0.000 01) and resting ECG (RR=1.30, 95%CI 1.15 to 1.45, P<0.000 1) in pericarpium trichosanthis injection combined with conventional western medicine group were superior to the conventional western medicine group. And the adverse reaction was rare and could be more tolerated in pericarpium trichosanthis injection combined with conventional western medicine group.ConclusionPericarpium trichosanthis injection combined with conventional western medicine can improve the symptoms of angina pectoris and objective indicator of ECG. However, due to the low quality of included studies and lack of evidence, the above results are needed to be validated by further well-designed multicenter, large scale, double blind RCTs.
Objective To evaluate the efficacy and safety of Chinese medicine for the treatment of angina pectoris. Methods PubMed, EMbase, The Cochrane Library (Issue 11, 2015), VIP, WanFang Data and CNKI databases were used to evaluate the curative effect and safety of proprietary Chinese medicine in the treatment of angina pectoris. The retrieval time was up to November 2015. Two reviewers screened literatures, extracted data and assessed the methodological quality of included studies, and then the GRADE evaluation system was used to assess the quality of evidence. Results A total of 42 systematic reviews/Meta-analysises were included in the study. There were 15 kinds of proprietary Chinese medicines, and the drugs published most were compound composite salvia. AMSTAR evaluation results showed that the quality of all studies were low. The main problems were: ① no consideration was given to the publication of the inclusion criteria (eg, gray literature); ② only the list of articles included in the study literature was not available; ③ all articles did not describe the relevant conflicts of interest. The results of GRADE systems showed that: ① as to the total effective rate: musk pills (RR=3.44, 95%CI 2.99 to 3.96,P=0.08) and suxiaojiuxin Pills (RR=4.25, 95% CI 3.31 to 5.47,P<0.01) were superior to Western medicine, and the level of evidence was very low. ② As to the ECG changes efficiency rate: Puerarin (RR=3.61, 95% CI 2.95 to 4.42,P=0.05), Musk pill (RR=2.48, 95%CI 2.12 to 2.91,P<0.01) and Shuxuening (RR=1.62, 95% CI 1.33 to1.97,P<0.01) were superior to Western medicine, and the evidence level was low. The level of evidence was low for the remaining effective rate of proprietary Chinese medicine; ③ as to the adverse reactions: the musk Baoxin pill (RR=0.05, 95% CI 0.01 to 0.37,P=0.04) was less than Western medicine, and the evidence level was low. Conclusion Although the number of systematic reviews of published proprietary Chinese medicines for angina pectoris is high, but the methodological quality and evidence level are low. There are serious defects in the low quality of the original research literature and the systematic evaluation method. We suggest future studies to improve for two aspects: ① reasonable design to reduce the selective bias, to carry out the required clinical trials to reduce the implementation bias, the implementation of multi-center, the sample size of sufficient randomized controlled clinical trials to reduce the number of patients into the group less resulting in the loss of bias, strict implementation of the standard data collection methods to reduce the occurrence of measurement bias; ② in accordance with the requirements of clinical trials to report to improve the report quality of the literature.
Objective To evaluate the cardiac protection function of high thoracic epidural anesthesia (HTEA) for patients with acute coronary syndrome or heart failure. Methods A literature search was conducted with computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1990 to May 2010. Further searches for articles were conducted by checking all references describing cardiac protection studies with HTEA. All included articles were assessed and data were extracted according to the standard of Cochrane review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results A total of 28 articles involving 1 041 patients were included. The results of meta-analyses showed that, a) cardiac function: HTEA could significantly improve ejection fraction of left ventricle (WMD= –?10.28, 95%CI –?14.14 to –?6.43) and cardiac output (WMD= –?1.26, 95%CI –?1.63 to –?0.89), contract left ventricular diastolic dimension (WMD= 5.02, 95%CI 3.72 to 6.32), increase E peak (WMD= –?17.50, 95%CI –?29.40 to –?5.59) and decrease A peak (WMD= 27.36, 95%CI 24.46 to 30.26); b) ischemic degree for patients with heart failure: the change of NST-T (WMD= 1.45, 95%CI 1.12 to 1.78) and ∑ST-T (WMD= 1.02, 95%CI 0.78 to 1.26) got significantly decreased after HTEA; c) ischemic degree for patients with acute coronary syndrome: HTEA could obviously lessen the times (WMD= 4.24, 95%CI 0.48 to 8.00) and duration (WMD= 23.29, 95%CI 4.66 to 42.11) of myocardial ischemia, decrease the times of heart attack (WMD= 3.44, 95%CI 0.92 to 5.97), and decrease the change of NST-T (WMD= 1.10, 95%CI 0.84 to 1.36) and ∑ST-T (WMD= 1.33, 95%CI 1.01 to 1.65); d) hemodynamic change for patients with acute coronary syndrome: HTEA could obviously decrease heart beat (WMD= 8.44, 95%CI 3.81 to 13.07) and systolic arterial pressure (WMD= 2.07, 95%CI 0.81 to 3.34), but not decrease the diastolic blood pressure (WMD= 2.06, 95%CI –?0.52 to 4.64) so as to avoid influencing the infusion of coronary artery; and e) influence on Q-T interval dispersion: HTEA could significantly decrease Q-Td (WMD= 9.51, 95%CI 4.74 to 14.27), Q-Tcd (WMD= 11.82, 95%CI 5.55 to 18.09), and J-Td (WMD= 9.04, 95%CI 2.30 to 15.79). Conclusions High thoracic epidural anesthesia can obviously improve the systolic and diastolic function of left ventricle, decrease the heart beat and stabilize hemodynamic change, lessen the times and duration for myocardial ischemia, reserve the ST segment change, contract Q-T interval dispersion, which has to be further proved with more high quality studies.