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Review
. 2018 Jun 4:9:550.
doi: 10.3389/fphar.2018.00550. eCollection 2018.

The Therapeutic Efficacy of Danhong Injection Combined With Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Jun-Bo Zou  1 , Xiao-Fei Zhang  1 , Jing Wang  1 , Fang Wang  2 , Jiang-Xue Cheng  1 , Fang-Yan Yang  1 , Xiao Song  1 , Yu Wang  1 , Yu-Lin Liang  1 , Ya-Jun Shi  1
Affiliations
Review

The Therapeutic Efficacy of Danhong Injection Combined With Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Jun-Bo Zou et al. Front Pharmacol. .

Abstract

Background: Percutaneous coronary intervention (PCI) is widely used in treatment of acute coronary syndrome (ACS) clinically. It is believed that Danhong injection (DHI) extracted from salviae miltiorrhizae and flos carthami combined with PCI could increase the therapeutic efficacy on ACS. We provide an updated meta-analysis with detailed information on combination of DHI and PCI therapy. Materials and Methods: Electronic databases were searched for appropriate articles without language limitations on key words before October 22, 2017. All trails were screened according to certain criteria. Quality of eligible studies was also assessed. We made a detailed record of outcome measurements. RevMan 5.3 software was used to perform the meta-analysis. Results: 14 articles involving 1533 patients with ACS were selected. Compared to PCI treatment alone, total efficacy rate (TER) was enhanced and major adverse cardiovascular events (MACE) were reduced significantly for the combination of DHI and PCI (P < 0.00001). Vascular endothelial function was improved by significantly decreasing the contents of ET-1, vWF and increasing the levels of NO and FMD (P < 0.00001). The serum levels of IL-1, IL-6, IL-18, TNF-α, LpPLA2, MMP-9, and pentraxin-3 were significantly decreased (P < 0.00001), whereas IL-10 in serum was increased (P < 0.00001), indicating a stronger anti-inflammatory effect of the combination. The combination therapy decreased the serum levels of CD62P, PAGT, PADT, FIB-C significantly (P < 0.05), which was beneficial for preventing coagulation of platelets. Blood lipid was also affected by regulating TC, TG, LDL, and HDL, but the results were not statistically significant (P > 0.05). Cardiac function was improved by increasing LEVF (P = 0.006) but not LVED (P = 0.08). The combination treatment was associated with an improvement in antioxidant effect by decreasing MDA and increasing SOD significantly (P < 0.00001). Conclusion: Combination of DHI and PCI in treatment of ACS could improve TER and reduce incidence of MACE after PCI therapy. These effects may be mediated by combined actions of several mechanisms. However, these results of this study should be handled cautiously due to the limitations of this research. Several rigorous RCTs are in need to confirm these findings.

Keywords: Danhong injection; acute coronary syndrome; meta-analysis; percutaneous coronary intervention; systematic review.

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Figures

FIGURE 1
FIGURE 1
Work flow of present study.
FIGURE 2
FIGURE 2
Process of study extracted for the meta-analysis.
FIGURE 3
FIGURE 3
Risk of bias assessment in eligible studies. The quality assessment was conducted by Review Manager 5.3 according to Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Red circle, high risk of bias; green circle, low risk of bias; blank, unclear risk of bias.
FIGURE 4
FIGURE 4
Forest plot of TER and MACE in patients treated with DHI + PCI and PCI alone. (A) The plot of TER, (B) the plot of MACE. I2 and P are the criterion for the heterogeneity test. ♦ Pooled odds ratio, —formula image— odds ratio and 95%CI.
FIGURE 5
FIGURE 5
Forest plot of indices of vascular endothelial function in patients treated with DHI + PCI and PCI alone. (A) The plot of ET-1, (B) the plot of NO, (C) the plot of vWF, and (D) the plot of FMD. I2 and P are the criterion for the heterogeneity test. ♦ Pooled odds ratio, —formula image—mean difference and 95%CI.
FIGURE 6
FIGURE 6
Forest plot of hsCRP in patients treated with DHI + PCI and PCI alone. I2 and P are the criterion for the heterogeneity test. ♦ Pooled odds ratio, —formula image—mean difference and 95%CI.
FIGURE 7
FIGURE 7
Funnel plot for the publication bias. (A) The plot of ET-1, (B) the plot of hsCRP, (C) the plot of NO, and (D) the plot of vWF. The funnel plots of these factors were symmetric, indicating that the publication was small.
See this image and copyright information in PMC

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