Objective To systematically review the effectiveness and safety of safflor yellow for unstable angina. Methods Relevant studies of safflor yellow for unstable angina were collected from databases including CENTRAL (Issue 4, 2012), MEDLINE, EMbase, CNKI, VIP, WanFang Data and CBM from January, 2007 to December, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 6 RCTs involving 533 patients were included, which were of low quality. The results of meta-analysis showed: compared with conventional treatment alone, safflor yellow plus routine biomedical treatment significantly improved the symptoms f angina (excellence: OR=2.34, 95%CI 1.79 to 4.87; effectiveness: OR=1.23, 95%CI 0.86 to 1.76). Besides, it significantly improved ECG outcomes (excellence: OR=1.85, 95%CI 1.29 to 2.64; effectiveness: OR=1.43, 95%CI 1.00 to 2.05), obviously improved the hemorheology index and blood lipid, reduced plasma homocysteine concentration, and increased the decreasing of nitroglycerin stop amount. No damage of the liver and kidney were reported. Conclusion Current evidence showed that, safflor yellow plus routine biomedical treatment is effective in the treatment of unstable angina, which is superior to routine biomedical treatment alone. Due to the limited quantity and quality of the included studies, more high quality, double blind, randomized controlled trials are needed to verify the above conclusion.
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.
Objective To assess the efficacy and safety of low-dose urokinase plus conventional treatment versus conventional treatment alone in patients with unstable angina. Methods We searched the database PubMed, EMBASE, The Cochrane Library, SCI, CBM, CNK, VIP and Wanfang database on line by computer, and handsearched relevant professional journals by two independent screening and extract information. The quality of the included documents was evaluated by the criterion of Cochrane handbook 4.2.6. The cochrane collaboration’s Revman 4.2.10 software was used for data analyses. Results A total of 19 randomized controlled trials were included (2 273 patients) Meta-analyses showed that the low-dose urokinase group was better than the conventional treatment group in efficiency [OR= 4.18, 95%CI (3.24, 5.41)] and ECG [OR= 2.81, 95%CI (2.04, 3.88)], and there were no differences between the two groups in cardiovascular outcomes [OR= 0.74, 95%CI (0.44,1.24)], mucocutaneous bleeding [OR= 1.43, 95%CI (0.90, 2.28)], gums bleeding [OR= 1.88, 95%Cl (0.46, 7.70)] and microscopic hematuria [OR= 3.82, 95%CI (0.77, 18.92)]. Conclusion The low dose urokinase group is higher efficient than the conventional treatment group. As the samples of the included studies are small and their quality is low, more randomized, double-blind, high-quality and big- sample trials are required.
目的:观察低分子肝素钙联合舒血宁(银杏叶提取物)治疗不稳定型心绞痛疗效。方法:选择符合诊断标准的不稳定型心绞痛患者88例。随机分为治疗组与对照组,对照组给予常规药物治疗,治疗组在常规治疗的基础上给予低分子肝素钙和舒血宁注射液治疗。结果:2周结束后治疗组各项观察指标较对照组明显改善,两组差异明显(Plt;005)。结论:低分子肝素钙联合舒血宁治疗不稳定型心绞痛效果显著。
Objective To evaluate the efficacy and safety of trimetazidine (TMZ) in the treatment of Stable Angina Pectoris (SAP). Methods Randomized controlled trials (RCTs) on the efficacy and safety of Trimetazidine in treating patients with SAP were retrieved in the following databases as CNKI (1997 to June 2011), WanFang Data (1989 to June 2011), MEDLINE (1966 to June 2011), EMbase (1974 to June 2011), CBM (1989 to June 2011) and Cochrane Central Database (1989 to June 2011). The literature which met the inclusion and exclusion criteria were selected, data were extracted, the quality was evaluated, and meta-analysis was performed by using RevMan 5.0 software. Results A total of 15 RCTs involving 1 500 patients were included. The meta-analysis showed that, compared with the control group, TMZ was significantly superior in the following 5 aspects: the time to 1 mm drop of ST segment (WMD=0.84, 95%CI 0.74 to 0.93, P=0.000 01), duration of doing exercise (WMD=0.82, 95%CI 0.73 to 0.91, P=0.000 01), and time to onset of angina (WMD=1.18, 95%CI 0.87 to 1.50, Plt;0.000 01) in the treadmill test, weekly mean number of angina attacks (WMD= –1.79, 95%CI –1.93 to –1.66, Plt;0.000 01), and weekly side effects between TMZ and the control group (RR=0.83, 95%CI 0.52 to 1.32, P=0.42). Conclusion Based on current studies, TMZ is superior to other medicines in the control group for SAP at present, and it has no significant difference in side effects compared with the control group, so it is regarded as an effective and safe drug. For the quality restrictions and possible publication bias of the included studies, this conclusion needs to be confirmed by more high quality, large sample, multi-center, double blind RCTs.
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 determine the benefits of an invasive compared to a conservative strategy for treating unstable anguba (UA)/ non-ST-elevation myocardial infarction (NSTEMI). Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1996 to September 2009), EMbase (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), and VIP (1989 to 2009). The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials involving 11 394 patients met the inclusion criteria. The results meta-analyses showed the incidence of all-cause mortality at six months follow-up was lower in the early invasive group compared with the conservative group (RR=0.75, 95%CI 0.61 to 0.92, P=0.007); the relative risk of myocardial infarction was significantly decreased in the early invasive group (RR=0.74, 95%CI 0.63 to 0.87); there was a reduction in rehospitalization for unstable angina in the invasive group (RR=0.66, 95%CI 0.61 to 0.73, Plt;0.000 01); the invasive strategy was associated with a two-fold increase in the relative risk of PCI-related myocardial infarction (as variably defined). There was not a significant increase in bleeding by an invasive strategy at six months follow-up, but, a routine invasive strategy was associated with a significantly higher bleeding rate at 1-year follow-up (RR=2.22, 95%CI 1.55 to 3.17, Plt;0.000 1). Patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker levels. Conclusion An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI, especially higher-risk patients with elevated cardiac biomarker benefit more from invasive strategy. In addition, complications such as procedure-MI and bleeding must be paid great attention to.
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.
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.