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

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.

Initiate Danhong Injection before or after percutaneous coronary intervention for microvascular obstruction in ST-elevation myocardial infarction (DIRECTION): study protocol for a randomized controlled trial

“…Compared with oral preparation, Danhong Injection has an advantage in taking rapid effect in the short time window of myocardial reperfusion. Systematic reviews have found that Danhong Injection is associated with improvement of reperfusion and LVEF, as well as reduction of MACE in acute coronary syndrome when combined with PCI [20,21].…”

“…A recent systematic review showed that Danhong Injection significantly reduced the risk of death and recurrent angina, arrhythmia, and heart failure and improved left ventricular ejection fraction (LVEF) and reperfusion in patients with AMI [20]. Compared with PCI alone, Danhong Injection combined with PCI can improve vascular endothelial function, reduce inflammation, and prevent platelet aggregation, suggesting that it may act on multiple pathological steps, improve myocardial microcirculation, and reduce reperfusion injury [21]. Several small-sample clinical trials demonstrated that Danhong Injection can reduce the occurrence of coronary no-reflow (Thrombolysis in Myocardial Infarction [TIMI] blood flow grade < 3 or corrected TIMI frame count >40s) in patients with MI and can promote postoperative microcirculation recovery (ST-segment resolution [STR] ≥ 70% or 50%) [22][23][24].…”

Investigating the multi-target pharmacological mechanism of danhong injection acting on unstable angina by combined network pharmacology and molecular docking

“…DHI is a mixed extraction of Salvia miltiorrhiza (DS; Dan Shen; family: Lamiaceae) and Carthami Flos (HH; Hong Hua; family: Compositae /Asteraceae) [15][16][17]. DHI has been widely used as an important adjuvant for the treatment of cardiovascular and cerebrovascular diseases in China [14,18,19]. Even more importantly, a previous study demonstrated that DHI combined with conventional medicines could improve the electrocardiogram and reduce the symptoms of angina for the treatment of UA [20].…”

Comparative Efficacy of Danshen Class Injections for Treating Acute Coronary Syndrome: A Multidimensional Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…According to accumulated evidenced-based data, the combination of CHIs and WM is associated with considerable efficacy in treating patients with ACS ( Zhao et al, 2018 ). For example, a systematic review reported that Danhong injection (DH) could improve the therapeutic efficacy and reduce the incidence of MACE events in ACS patients after PCI ( Zou et al, 2018 ). Moreover, systematic reviews and meta-analysis studies shown that Sodium Tanshinone IIA Sulfonate injection (STS) and Danshenchuanxiongqin injection (DSCXQ) combined with WM appeared to be efficacious in the treatment UA ( Zhang et al, 2016 ; Tan et al, 2018 ).…”

“…Moreover, NMA can assist assessing and ranking the therapeutic effects of different treatments ( Rouse et al, 2017 ; Pan et al, 2019 ). However, at present, there are many systematic review studies on the adjuvant treatment of ACS with a certain type of DSCIs, lacking of comparison of efficacy between different types of DSCI ( Wu et al, 2015 ; Zhang et al, 2016 ; Wu et al, 2017 ; Tan et al, 2018 ; Zou et al, 2018 ). Therefore, the present research adopted NMA to explore the comparative effectiveness and safety between different DSCIs plus WM against ACS, providing a reference for clinical practice.…”