AUTHOR=Li Min , Li Chengyu , Chen Shiqi , Sun Yang , Hu Jiayuan , Zhao Chen , Qiu Ruijin , Zhang Xiaoyu , Zhang Qin , Tian Guihua , Shang Hongcai 

TITLE=Potential Effectiveness of Chinese Patent Medicine Tongxinluo Capsule for Secondary Prevention After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

JOURNAL=Frontiers in Pharmacology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2018.00830

DOI=10.3389/fphar.2018.00830

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Chinese patent medicine <italic>Tongxinluo capsule</italic> (<italic>TXL</italic>) is commonly used for cardio-cerebrovascular diseases. Previous research had demonstrated that <italic>TXL</italic> exhibited great clinical effects on the treatment of acute myocardial infarction (AMI), however there is a lack of systematic review. The purpose of this study was to evaluate the potential effectiveness and safety of <italic>TXL</italic> for secondary prevention in patients with AMI.</p><p><bold>Method:</bold> We searched 6 databases to identify relevant randomized controlled trials (RCTs) from inceptions to December 30, 2017. Two review authors independently assessed the methodological quality and analyzed data by the RevMan 5.3 software. The publication bias was assessed through funnel plot and Begg's test. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for evaluating the quality of evidence.</p><p><bold>Results:</bold> We included 19 RCTs in this review and performed a meta-analysis based on 16 studies. There were statistical differences of <italic>TXL</italic> treatment group in reducing primary cardiovascular events (cardiac death [RR = 0.27, 95%CI: 0.08~0.95, <italic>I</italic><sup>2</sup> = 0%], recurrent myocardial reinfarction [RR = 0.38, 95%CI: 0.20~0.74, <italic>I</italic><sup>2</sup> = 0%], arrhythmia [RR = 0.44, 95%CI: 0.30~0.66, <italic>I</italic><sup>2</sup> = 0%], recurrent angina pectoris [RR = 0.34, 95%CI: 0.17~0.69, <italic>I</italic><sup>2</sup> = 0%]). <italic>TXL</italic> could improve cardiac function (LVEF [MD = 4.10, 95%CI: 3.95~4.25, <italic>I</italic><sup>2</sup> = 0%]), regulate blood lipid TC [MD = −0.66, 95%CI: −0.94 ~ −0.37, <italic>I</italic><sup>2</sup> = 74%], TG [MD = −0.38, 95%CI: −0.62 ~ −0.14, I<sup>2</sup> = 70%], LDL-C[−0.40, 95%CI: −0.65 ~ −0.16, <italic>I</italic><sup>2</sup> = 88%), decrease the level of hs-CRP (4-week: MD = −0.78, 95%CI: −0.97 ~ −0.60, <italic>I</italic><sup>2</sup> = 20%; Over 4-week: MD = −1.36, 95%CI: −1.55 ~ −1.17, <italic>I</italic><sup>2</sup> = 20%). However, <italic>TXL</italic> has little effects on revascularization [RR = 0.45, 95%CI: 0.13~1.56, <italic>I</italic><sup>2</sup> = 0%], recurrent heart failure (RR = 0.83, 95%CI: 0.27~2.57, <italic>I</italic><sup>2</sup> = 0%), and HDL-C (MD = 0.14, 95%CI: 0.00 ~0.29, <italic>I</italic><sup>2</sup> = 73%). Furthermore, <italic>TXL</italic> treatment group was more prone to suffer gastrointestinal discomfort.</p><p><bold>Conclusion:</bold> Chinese patent medicine <italic>TXL</italic> seemed beneficial for secondary prevention after AMI. This potential benefit needs to be further assessed through more rigorous RCTs.</p><p>Systematic review registration number in the PROSPERO register: CRD42017068417.</p>