AUTHOR=Guo Hongxin , Li Xingyuan , Zhu Mingjun 

TITLE=Meta-analysis and trial sequential analysis of shexiang baoxin pill for coronary slow flow

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.955146

DOI=10.3389/fphar.2022.955146

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Coronary slow flow (CSF) is a common cardiovascular phenomenon with no effective treatment in conventional Western medicine (CWM). Shexiang Baoxin Pill (SXBXP) is a widely used Chinese medicine for cardiovascular disease in China, and clinical studies have shown that it has good efficacy for CSF.</p><p><bold>Objective:</bold> To systematically evaluate the efficacy and safety of SXBXP for CSF.</p><p><bold>Methods:</bold> Seven databases were searched to identify related randomized controlled trials (RCTs). The Meta-analysis, trial sequential analysis (TSA), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were performed using Stata 14.1, TSA 0.9.5.10 Beta and GRADE profiler 3.2.2 software respectively.</p><p><bold>Results:</bold> A total of 10 RCTs were included. Meta-analysis showed that compared with CWM treatment alone, SXBXP combined with CWM further improved the angina pectoris efficacy [RR = 1.37, 95% CI (1.23, 1.52), <italic>p</italic> &lt; 0.000 01] and nitric oxide (NO) level [WMD = 11.32, 95% CI (0.04, 22.59), <italic>p</italic> = 0.049], decreased the mean corrected TIMI frame count (CTFC) [WMD = −4.23, 95% CI (−5.51, −2.95), <italic>p</italic> &lt; 0.000 01], CTFC of the left anterior descending artery (LAD) [WMD = −6.36, 95% CI (−12.07, −0.65), <italic>p</italic> = 0.029], left circumflex artery (LCX) [WMD = -5.73, 95% CI (−8.79, −2.67), <italic>p</italic> &lt; 0.000 01], and right coronary artery (RCA) [WMD = −6.72, 95% CI (−10.60, −2.84), <italic>p</italic> = 0.001], decreased the positive rate of treadmill exercise test [RR = 0.45, 95% CI (0.25, 0.83), <italic>p</italic> = 0.010], endothelin-1 (ET-1) level [WMD = -11.03, 95% CI (−13.92, −8.14), <italic>p</italic> &lt; 0.000 01], high-sensitivity C-reactive protein (hs-CRP) [WMD = −1.95, 95% CI (−2.57, −1.34), <italic>p</italic> &lt; 0.000 01], and adverse reactions [RR = 0.20, 95% CI (0.05, 0.85), <italic>p</italic> = 0.030]. The GRADE evidence quality rating presented with moderate, low or very low quality of evidence. TSA further affirmed the clinical efficacy.</p><p><bold>Conclusion:</bold> Although some results suggest that there may be a positive effect of SXBXP for CSF, the quality of the primary study including the reporting is too poor and therefore, no benefits could be demonstrated. More high-quality studies are still needed to further confirm the efficacy and safety.</p><p><bold>Systematic review registration:</bold><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/PROSPERO/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/PROSPERO/</ext-link>, identifier (CRD42022329469).</p>