Comparative efficacy and safety of Chinese patent medicines in coronary heart disease patients after percutaneous coronary intervention: A systematic review and network meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: TXLJN + CT ranked first in SUCRA analysis for MACE reduction

• Primary Outcome: Major adverse cardiovascular events (MACEs)

• Nnt Or Sensitivity: SUCRA rankings provided for intervention effectiveness hierarchy

• Confidence Interval: Various 95% CIs reported for different outcomes (e.g., LVEDD: SMD -1.01, 95% CI -1.35 to -0.66)

Clinical Application

Limited feasibility in Australian practice due to regulatory status and availability of Chinese patent medicines Chinese patent medicines not readily available through PBS or TGA-approved pathways. Limited applicability to Australian cardiology practice where evidence-based conventional therapies remain standard of care post-PCI Post-PCI coronary heart disease patients, particularly in healthcare systems with access to Chinese patent medicines

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE: Patients with coronary heart disease (CHD) remain at high risk of major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Chinese Patent Medicines (CPMs) have demonstrated therapeutic potential as adjunctive therapies, however, direct comparative evidence regarding their effectiveness is lacking. AIM OF THE STUDY: This network meta-analysis (NMA) aims to systematically evaluate and compare the clinical efficacy and safety of CPMs combined with conventional therapy (CT) in post-PCI management. MATERIALS AND METHODS: A systematic literature search was performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP, and Wanfang databases up to December 24, 2024. Randomized controlled trials investigating CPMs in CHD patients following PCI were included. Methodological quality was assessed using the Cochrane Risk of Bias tool. Outcome measures included major adverse cardiovascular events (MACEs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and nitric oxide (NO) levels. NMA was implemented using STATA 16.0 and R 4.1.2. Odds ratios and standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. Model selection was guided by heterogeneity assessed using the I2 statistic. Intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA), with robustness and publication bias evaluated through sensitivity analyses and funnel plots. RESULTS: A total of 84 RCTs involving 10,524 patients and eight CPMs were included. For the primary outcome (MACEs), the SUCRA ranking indicated that Tongxinluo capsules combined with conventional therapy (TXLJN + CT) was the most effective intervention, followed by Shensong Yangxin capsules plus CT (SSYXJN + CT), Shexiang Baoxin pills plus CT (SXBXW + CT), Qili Qiangxin capsules plus CT (QLQXJN + CT), Qishen Yiqi dripping pills plus CT (QSYQDW + CT), Xinyu capsules plus CT (XYJN + CT), Fufang Danshen Dripping Pills plus CT (FFDSDW + CT), and Guanxin Shutong capsules plus CT (GXSTJN + CT), while CT alone ranked last. Correspondingly, the NMA demonstrated that TXLJN + CT was associated with the greatest reduction in LVEDD (SMD -1.01, 95% CI -1.35 to -0.66) and hs-CRP levels (SMD -2.50, 95% CI -3.33 to -1.68). The most significant improvement in LVEF (SMD 1.25, 95% CI 0.85 to 1.64) and NO levels (SMD 1.02, 95% CI 0.73 to 1.29) was observed with QSYQDW + CT. Meanwhile, SXBXW + CT showed the greatest efficacy in reducing NT-proBNP levels (SMD -3.43, 95% CI -4.68 to -2.18). CONCLUSION: CPMs combined with CT may provide clinical benefits in post-PCI management. According to SUCRA rankings, TXLJN + CT ranked first in reducing MACE and in lowering LVEDD and hs-CRP levels. QSYQDW + CT ranked first in improving LVEF and NO levels, while SXBXW + CT showed the highest ranking for reducing NT-proBNP levels. However, larger-scale, high-quality RCTs are needed to validate these findings.

References

1. 1.Wang, A., Wei, J., Yu, R., Zhao, Q., Wang, X., Li, B., & Zhu, M. (2026). Comparative efficacy and safety of Chinese patent medicines in coronary heart disease patients after percutaneous coronary intervention: A systematic review and network meta-analysis. Journal of Ethnopharmacology, 121377. https://doi.org/10.1016/j.jep.2026.121377