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The efficacy of Chinese herbal medicines on acute coronary syndrome with renal insufficiency after percutaneous coronary intervention

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE
Fufang Chuanxiong capsule consists of Angelica sinensis radix and Chuanxiong rhizome, which are used in the traditional Chinese medicine for the treatment of coronary artery disease, and Xinyue capsule is composed of panax quinquefolius saponin extracted from leaves and stems of Panax quinquefolium L, which has the functions of anti-myocardial ischemia, improving myocardial energy metabolism and inhibiting apoptosis of cardiomyocytes.

OBJECTIVE
To observe the role of Chinese herbal medicines in the cardiovascular outcome among patients with acute coronary syndrome (ACS) and renal insufficiency after percutaneous coronary intervention (PCI).

METHODS
The subjects came from the 5C trial (chictr.org number: chictr-trc-07000021), post-PCI patients suffered from ACS with mild-to-moderate renal insufficiency (30 mL•min-1•1.73 m-2 < estimated glomerular filtration rate≤89 mL•min-1•1.73 m-2) included. The study population consisted of 215 subjects in the control group who were treated with western medicine standard therapy, and 211 subjects in the treatment group who were treated with Chinese herbal medicines (Fufang Chuanxiong Capsule and Xinyue Capsule) for 6 months on the basis of western medicine standard therapy. All were followed for 1 year. The primary endpoint included the composite of cardiac death, nonfatal recurrent myocardial infarction, and ischemia-driven revascularization. Secondary endpoint included the composite of stroke, congestive heart failure, and readmission for ACS. The serum creatinine and estimated glomerular filtration rate (eGFR) were evaluated.

RESULTS
After 1 year follow-up of two groups, there were 16 cases of primary endpoint in the control group and 6 cases of primary endpoint in the treatment group [absolute risk reduction (ARR): 0.046, 95%CI: 0.004-0.088; relative risk (RR): 0.38, 95%CI: 0.15-0.96, P = 0.040]. There were 15 cases of secondary endpoint in the control group and 5 cases of secondary endpoint in the treatment (ARR: 0.041, 95%CI: 0.006-0.086; RR: 0.34, 95%CI: 0.13-0.92, P = 0.033). The eGFR in the treatment group was significantly higher than that in the control group (75.19 ± 16.74 mL min-1·1.73 m-2 VS 72.03 ± 14.96 mL min-1·1.73 m-2, P < 0.05). The eGFR in the treatment group was significantly higher after the intervention with Chinese herbal medicines than that before intervention (72.27 ± 11.83 mL min-1·1.73 m-2 VS 75.19 ± 16.74 mL min-1·1.73 m-2, P < 0.05).

CONCLUSION
Chinese herbal medicines plus western medicine standard therapy improved clinical outcomes in patients with ACS and mild-to-moderate renal insufficiency. Additionally, this study also demonstrated Chinese herbal medicines were useful in deferring decline of renal function.

Authors: Zhang DW, Wang SL, Wang PL, Du JP, Gao ZY, Wang CL, Xu H, Shi DZ

Published in: J Ethnopharmacol. 2020 Feb 10;248:112354. doi: 10.1016/j.jep.2019.112354. Epub 2019 Nov 2.

Quelle: https://www.sciencedirect.com/science/article/abs/pii/S0378874119317441?via%3Dihub

Kommentar: Xinyue Kapsel: Panax quinquefolium (Xi Yang Shen; amerikianischer Ginseng), Fufang Kapsel: Rx. Angelica sinensis (Dang Gui), Rhiz. Chuanxiong (Chuan Xiong); Adjuvant zur Standardtherapie mit ASS, Clopidogrel, Statinen