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Abstract

Objective: A comprehensive summary and evaluation of the current evidence profile of the role of traditional Chinese medicine (TCM) in myocardial infarction management was conducted to provide evidence-based recommendations for clinical application and evoke thoughts for future researchers. Methods: We systematically searched CNKI, VIP, CBM, PubMed and the Cochrane Library for literature on TCM for myocardial infarction. After screening, studies were categorized in terms of type into five levels, i.e. systematic review (SR), randomized controlled trial (RCT), observational study, case study and basic research. General information was abstracted, and quality of these studies and conclusions made were summarized and assessed. Results: A total of 452 studies involving 10 SRs, 123 RCTs, 47 observational studies, 28 case studies and 244 basic researches were included. Clinical studies centered primarily on herbal decoction and most were not rigorously performed. High quality studies were predominantly on patent drugs such as Danshen injection, Shenmai injection, Shengmai injection and Qishen Yiqi dripping pills. The most frequently observed pattern of drug combinations was decoction plus injection. A summary of findings from systematic reviews and clinical research show that TCM may reduce mortality, decrease risk for complication, reduce myocardial injury, improve cardiac function and inhibit ventricular remodeling. Results of experimental studies also support the active role of TCM in reducing infarct size and myocardial injury, promoting angiogenesis, preventing ventricular remodeling and improving cardiac function. According to the current bodies of evidence, TCM has proven effects in the prevention and treatment of myocardial infarction. It is also found that the effects of Chinese patent drugs vary with indications. For instance, Shenmai injection has been observed especially effective for reducing incidence of acute clinical events, and patent drug with qi-nourishing and blood-circulating properties has been proved good at inhibiting ventricular remodeling. High-quality evidence supports the use of TCM injection for acute myocardial infarction and Chinese patent drug medication for secondary prevention. Reports on adverse events and other safety outcomes associated with Chinese medicine for myocardial infarction are not many, but the current evidence indicates a good safety profile of TCM. Conclusion: Firstly, sufficient evidence has been drawn from all five types of studies in relation to the use of TCM as an adjuvant to conventional Western medicine for prevention and treatment of myocardial infarction. Scientific and rational use of TCM in combination with western medicine is therefore recommended, taking into consideration of the stage of the disease and therapeutic goals of the patients. For example, herbal decoction and Qishen Yiqi dripping pills are recommended for patients recovering from a myocardial infarction and for secondary prevention, whereas for patients with acute myocardial infarction Shenmai injection would be a good choice. Secondly, the quality of the bodies of evidence remains to be enhanced, and improvements can be made from the following aspects: 1) Some significant research subjects are worthy of further exploration, such as the benefits of and potential risks posed by the concomitant use of Chinese medicine and western drugs with cardiovascular protective properties; 2) The quality of both original and secondary research need to be enhanced, and the system for clinical evaluation of TCM shall be rigorously constructed; 3) Highlights should be given to the monitoring and reporting of adverse events associated with the use of Chinese medicine; and 4) To promote standard reporting of TCM clinical research.