Objective To investigate the current situation of clinical studies on puerarin for angina pectoris and assess whether it is adequate to provide evidence for clinical practiice. Methods We collected all the published clinical studies on puerarin for angina pectoris from 1966 to October 2003, and assessed all the included reports according to international clinical epidemiological standard. Results 106 RCTs, 8 non-randomized controlled studies and 24 case series were included and analyzed. 126 studies reported diagnosis criteria, 10 desccribed inclusion criteria; 3 studies were quasi-random, 1 double blind, 4 single blind; no study reported follow-up; 117 studies reported adverse effects. Conclusions Currently the quality of studies on puerarin for angina pectoris is not good enough to provide reliable evidence for clinical practice.
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 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 investigate the current situation of randomized controlled trials (RCTs) on compound salvia pellet (CSP) for angina pectoris and assess whether there is adequate evidence for clinical practice. Methods We collected all the published clinical studies on CSP for angina pectoris from 1994 to December 2005, and assessed each included report using the Jadad scale, the revised CONSORT statement and other self-edited items. Results We finally identified 115 RCTs. Among which, 1 scored 3 points, 6 scored 2 points, 106 scored 1 points and 2 socred 0 points. No RCT performed allocation concealment according to the CONSORT criteria, only 4 RCTs (3.5%) described the generation of the randomization sequence, among which 2 were quasi-randomized. No RCT provided randomization implementation,1 RCT (0.9%) carried out placebo control, 1 RCT (0.9%) reported endpoint, 9 RCTs (7.8%) adopted single blinding, 4 RCTs (3.5%) reported double blinding, 11 RCTs (9.6%) calculated statistical values, 2 RCTs (1.7%) provided the record of follow-up, 1 RCT (0.9%) reported negative outcome, 25 RCTs (21.8%) described adverse events, no RCT described how the sample size was estimated, and how an intent-to-treat (ITT) analysis and correlation analysis were reported, 1 RCT (0.9%) was multi-center, no RCT completed ethical approval and informed consent, 27 RCTs (23.5%) described syndrome type of TCM. Conclusion Currently, the methodology and reporting of studies on CSP for angina pectoris are not good enough to provide reliable evidence for clinical practice.
ObjectiveTo systematically review the effectiveness and safety of salvianolate injection and Danshen injection for patients with angina pectoris, and evaluate the cost of drug. MethodsWe electronically searched databases including PubMed, CENTRAL (Issue 4, 2013), CNKI, VIP and WanFang Data (2004.1 to 2013.5) for the randomized controlled trials (RCTs) on the comparison between salvianolate injection and Danshen injection for angina pectoris from January 2004 to May 2013. Relevant journals and conference proceedings were also manually retrieved. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria, extracted the data and assess the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 196 patients were included. The results of meta-analysis showed that, salvianolate injection was obviously superior to Danshen injection in the effectiveness (OR=3.79, 95%CI 2.78 to 5.17, P < 0.000 01) and safety (OR=0.24, 95%CI 0.09 to 0.64, P=0.004), but lack of economic advantages in the treatment of the angina pectoris diseases. ConclusionCurrent evidence indicates that, salvianolate injection is a safe and effective scheme for angina pectoris, and Danshen injection is considered as a economic method. Because of the limited quantity and quality of currently-available research, the aforementioned conclusion should be verified by strictly-designed and large-scale sample RCTs.
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 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 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.