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Frontiers in Pharmacology 2022Coronary slow flow (CSF) is a common cardiovascular phenomenon with no effective treatment in conventional Western medicine (CWM). Shexiang Baoxin Pill (SXBXP) is a...
Coronary slow flow (CSF) is a common cardiovascular phenomenon with no effective treatment in conventional Western medicine (CWM). Shexiang Baoxin Pill (SXBXP) is a widely used Chinese medicine for cardiovascular disease in China, and clinical studies have shown that it has good efficacy for CSF. To systematically evaluate the efficacy and safety of SXBXP for CSF. Seven databases were searched to identify related randomized controlled trials (RCTs). The Meta-analysis, trial sequential analysis (TSA), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were performed using Stata 14.1, TSA 0.9.5.10 Beta and GRADE profiler 3.2.2 software respectively. A total of 10 RCTs were included. Meta-analysis showed that compared with CWM treatment alone, SXBXP combined with CWM further improved the angina pectoris efficacy [RR = 1.37, 95% CI (1.23, 1.52), < 0.000 01] and nitric oxide (NO) level [WMD = 11.32, 95% CI (0.04, 22.59), = 0.049], decreased the mean corrected TIMI frame count (CTFC) [WMD = -4.23, 95% CI (-5.51, -2.95), < 0.000 01], CTFC of the left anterior descending artery (LAD) [WMD = -6.36, 95% CI (-12.07, -0.65), = 0.029], left circumflex artery (LCX) [WMD = -5.73, 95% CI (-8.79, -2.67), < 0.000 01], and right coronary artery (RCA) [WMD = -6.72, 95% CI (-10.60, -2.84), = 0.001], decreased the positive rate of treadmill exercise test [RR = 0.45, 95% CI (0.25, 0.83), = 0.010], endothelin-1 (ET-1) level [WMD = -11.03, 95% CI (-13.92, -8.14), < 0.000 01], high-sensitivity C-reactive protein (hs-CRP) [WMD = -1.95, 95% CI (-2.57, -1.34), < 0.000 01], and adverse reactions [RR = 0.20, 95% CI (0.05, 0.85), = 0.030]. The GRADE evidence quality rating presented with moderate, low or very low quality of evidence. TSA further affirmed the clinical efficacy. Although some results suggest that there may be a positive effect of SXBXP for CSF, the quality of the primary study including the reporting is too poor and therefore, no benefits could be demonstrated. More high-quality studies are still needed to further confirm the efficacy and safety. https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022329469).
PubMed: 36071856
DOI: 10.3389/fphar.2022.955146 -
European Heart Journal. Quality of Care... Feb 2023We aimed to investigate the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and clinical outcome using a systematic... (Meta-Analysis)
Meta-Analysis
AIMS
We aimed to investigate the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and clinical outcome using a systematic review with a study-level meta-analysis.
METHODS AND RESULTS
MEDLINE, Embase, and CENTRAL were systematically searched for articles with clinical follow-up reporting mean or median final post-PCI FFR. The main outcome was a composite of major adverse cardiac events (MACE) including all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Meta-regression analyses were performed on mean post-PCI FFR values. A total of 62 studies with 12 340 patients and 12 923 stented vessels were included, with follow-ups ranging from 1 to 89 months. Post-PCI FFR was not continuously associated with the rate of 1-year MACE or 1-year TVR using meta-regression models accounting for heterogeneous follow-up lengths. For studies comparing high vs. low post-PCI FFR, low post-PCI FFR was associated with high risk ratio for MACE {1.97 [95% confidence interval (CI):1.45-2.67]}, all-cause death [1.59 (95% CI: 1.08-2.34)], MI [3.18 (95% CI: 1.84-5.50)], TVR [2.08 (95% CI: 1.63-2.65)] and angina status [2.50 (95% CI: 1.53-4.06)] using different optimal cut-off values spanning from 0.80 to 0.95.
CONCLUSION
We found no clear continuous association between post-PCI FFR and clinical outcomes in this systematic study-level meta-analysis. In a subset of studies investigating binary classification, high post-PCI FFR was associated with a better clinical outcome than low post-PCI FFR.We investigated the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and rate of major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR), using a systematic review and study-level meta-analysis, pooling 12 340 patients from 62 studies. Mean post-PCI FFR was not continuously associated with a 1-year MACE rate accounting for heterogenous follow-up lengths. Still, the risk ratio favoured high post-PCI FFR for reduced MACE, all-cause death, MI, TVR, and better angina status using different cut-offs.
Topics: Humans; Coronary Artery Disease; Coronary Angiography; Fractional Flow Reserve, Myocardial; Percutaneous Coronary Intervention; Treatment Outcome; Myocardial Infarction; Angina Pectoris
PubMed: 36026514
DOI: 10.1093/ehjqcco/qcac053 -
Frontiers in Cardiovascular Medicine 2022Cardiac syndrome X (CSX) is a condition with normal coronary angiography but angina pectoris. Chronic inflammation caused by () infection may play a pathogenic role in...
PURPOSE
Cardiac syndrome X (CSX) is a condition with normal coronary angiography but angina pectoris. Chronic inflammation caused by () infection may play a pathogenic role in CSX. Therefore, we conducted a meta-analysis to explore the relationship between infection and risk of CSX.
METHODS
A systematic search in the Web of Science, Medline, Embase and Chinese databases (CNKI and Wanfang) was conducted up to October 2021. Articles on the association between infection and the risk of CSX were included and were analyzed by R software (version 4.1.0).
RESULTS
Ten case-control studies involving 703 CSX patients and 731 healthy controls were included. infection was associated with an increased risk of CSX (OR: 8.29, 95% CI: 4.64-14.82). We also found a significant association in those 25-40 years of age (OR: 1.34, 95% CI: 1.04-1.72), those 40-50 years of age (OR: 11.27, 95% CI: 4.29-29.61), those over 50 years of age (OR: 7.18, 95% CI: 3.59-14.36), those in developing countries [Iran (OR: 12.99, 95% CI: 8.61-19.60) and China (OR: 5.14, 95% CI: 3.09-8.56)]. However, this association was not apparent in a developed country [Italy (OR: 0.93, 95% CI: 0.37-2.33)].
CONCLUSIONS
Our study suggested a possible association between infection and the risk of CSX. Its pathogenicity is stronger in middle-aged individuals and some developing countries. However, more studies are needed to further investigate whether early eradication of can reduce the incidence rate of CSX, especially in middle-aged individuals and some developing countries.
PubMed: 35911519
DOI: 10.3389/fcvm.2022.823885 -
Advances in Therapy Sep 2022Beta-blockers are recommended by the European Society of Cardiology as first-line antianginal therapy for reducing heart rate (HR) and symptoms in patients with chronic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Beta-blockers are recommended by the European Society of Cardiology as first-line antianginal therapy for reducing heart rate (HR) and symptoms in patients with chronic coronary syndrome, despite a lack of data showing superiority to other antianginal agents. Most patients with angina pectoris require combination therapy to manage symptoms, with a second-line agent chosen to manage the predominant cardiovascular problem. Ivabradine, a selective sinus node I channel inhibitor shown to reduce HR and protect against anginal symptoms, has previously demonstrated noninferior anti-ischaemic and antianginal efficacy to beta-blockers.
METHODS
This systematic review and meta-analysis assessed the efficacy and safety of ivabradine in patients with stable angina pectoris who remained symptomatic despite receiving beta-blockers. Keyword searches of PubMed, The Cochrane Central Library Register, ClinicalTrials.gov, The World Health Organization International Clinical Trials Registry Platform (ICTRP) and Google Scholar identified studies comparing ivabradine plus beta-blockers with placebo or other first- or second-line antianginal agents in patients with stable angina pectoris. No date limits or language restrictions were applied. Outcomes were evaluated after 1 and 4 months of treatment, including changes in HR, angina attacks, use of short-acting nitrates, quality of life and safety. Risk of bias was evaluated on the basis of recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS
Seven relevant studies were identified (N = 6821). Ivabradine plus a beta-blocker consistently reduced HR, anginal symptoms and short-acting nitrate consumption within 1 month of initiating therapy, with continued reductions for up to 4 months. Furthermore, ivabradine plus beta-blocker therapy was well tolerated, with bradycardia rarely reported (0.1% of patients overall). This study is limited by the inclusion of only two randomised studies, which may lead to result interpretation bias.
CONCLUSIONS
Ivabradine may be valuable for tailoring early antianginal treatment when used in combination with beta-blockers for chronic stable angina inadequately controlled by beta-blockers.
Topics: Adrenergic beta-Antagonists; Angina, Stable; Benzazepines; Cardiovascular Agents; Drug Therapy, Combination; Heart Rate; Humans; Ivabradine; Nitrates; Quality of Life; Treatment Outcome
PubMed: 35842897
DOI: 10.1007/s12325-022-02222-1 -
Laboratory Medicine Nov 2022We evaluated the relevant published studies exploring the association between chemerin concentrations and acute coronary syndromes (ACSs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We evaluated the relevant published studies exploring the association between chemerin concentrations and acute coronary syndromes (ACSs).
METHODS
A systematic search was performed in October 2021 using PubMed, Scopus, Embase, and Cochrane Library. We included full articles and assessed their quality using the Newcastle-Ottawa score.
RESULTS
We found 6 studies in the systematic review and 5 of these were included in our meta-analysis. Mean difference (MD) of 41.69 ng/mL (95% CI, 10.07-73.30), 132.14 ng/mL (95% CI, -102.12-366.40), and 62.10 ng/mL (95% CI, 10.31-113.89) in chemerin levels was seen in ACS patients vs control subjects, ACS patients vs stable angina pectoris patients (SAP), and type 2 diabetes mellitus (T2DM) ACS patients vs nondiabetic ACS patients, respectively.
CONCLUSION
Chemerin levels were significantly elevated in patients with ACS compared to controls, as well as in T2DM-ACS patients compared to nondiabetic ACS patients. However, no significant MD in chemerin levels was observed between SAP and ACS patients.
Topics: Humans; Acute Coronary Syndrome; Diabetes Mellitus, Type 2; Angina, Stable
PubMed: 35770793
DOI: 10.1093/labmed/lmac059 -
Cardiovascular Drugs and Therapy Feb 2024Coronary vasomotor dysfunction embraces two specific clinical entities: coronary (micro)vascular spasm and microvascular dysfunction. The clinical manifestations of... (Review)
Review
PURPOSE
Coronary vasomotor dysfunction embraces two specific clinical entities: coronary (micro)vascular spasm and microvascular dysfunction. The clinical manifestations of these entities are respectively called vasospastic angina (VSA) and microvascular angina (MVA). Over the years, these diseases have become more and more prominent and several studies aimed to investigate the best diagnostic and therapeutic strategies. Patients with coronary vasomotor disorders are often undertreated due to the absence of evidence-based guidelines. The purpose of this overview is to illustrate the various therapeutic options available for the optimized management of these patients.
METHODS
A Medline search of full-text articles published in English from 1980 to April 2022 was performed. The main analyzed aspects of vasomotor disorders were treatment options. We also performed research on "Clinicaltrial.gov" for ongoing trials.
CONCLUSION
Coronary (micro)vascular spasm and microvascular dysfunction are clinical entities characterized by high prevalence and clinical representation. Several therapeutic strategies, both innovative and established, are available to optimize treatment and improve the quality of life of these patients.
Topics: Humans; Coronary Vessels; Quality of Life; Microvascular Angina; Coronary Disease; Spasm; Coronary Angiography
PubMed: 35678926
DOI: 10.1007/s10557-022-07351-x -
Frontiers in Pharmacology 2022The objective of this study was to assess the efficacy and potential mechanisms of Chinese herbal medicine (CHM) for treating coronary heart disease (CHD) patients with...
The objective of this study was to assess the efficacy and potential mechanisms of Chinese herbal medicine (CHM) for treating coronary heart disease (CHD) patients with anxiety or depression. A systematic literature search was performed. Screening studies, extracting data, and assessing article quality were carried out independently by two researchers. The active ingredients of CHM for the treatment of CHD with anxiety or depression were analyzed by the network pharmacology, and the main potential mechanisms were summarized by the database of Web of Science. A total of 32 studies were included. The results showed that compared with the blank control groups, CHM was more beneficial in treating anxiety or depression in patients with CHD [anxiety: OR = 3.22, 95% CI (1.94, 5.35), < 0.00001, I = 0%; depression: OR = 3.27, 95% CI (1.67, 6.40), = 0.0005, I = 0%], and the efficacy of CHM was not inferior to that of Western medicine (WM) [anxiety: OR = 1.58, 95%CI (0.39, 6.35), = 0.52, I = 67%; depression: OR = 1.97, 95%CI (0.73, 5.28), = 0.18, I = 33%,]. Additionally, CHM also showed a significant advantage in improving angina stability (AS) in CHD patients with anxiety or depression compared with blank groups [anxiety: SMD = 0.55, 95%CI (0.32, 0.79), < 0.00001, I = 0%; depression: = 0.004] and WM groups [anxiety: SMD = 1.14, 95%CI (0.80, 1.47), < 0.00001, I = 0%; depression: SMD = 12.15, 95%CI (6.07, 18.23), < 0.0001, I = 0%]. Angina frequency (AF) and electrocardiogram (ECG) analysis after using CHM demonstrated similar trends. Based on the network pharmacology, quercetin, kaempferol, luteolin, beta-sitosterol, puerarin, stigmasterol, isorhamnetin, baicalein, tanshinone IIa, and nobiletin were most closely and simultaneously related to the pathological targets of CHD, anxiety, and depression. The main underlying mechanisms might involve anti-damage/apoptosis, anti-inflammation, antioxidative stress, and maintaining neurotransmitter homeostasis. CHM exhibited an obvious efficacy in treating CHD patients with anxiety or depression, especially for improving the symptom of angina pectoris. The most active compounds of CHM could simultaneously act on the pathological targets of CHD, anxiety, and depression. Multiple effective components and multiple targets were the advantages of CHM compared with WM.
PubMed: 35600859
DOI: 10.3389/fphar.2022.854292 -
Journal of Thoracic Disease Apr 2022Many studies have reported potential benefits of percutaneous coronary intervention (PCI) versus optimal drug therapy (ODT) for patients with stable coronary heart...
Evaluating the efficacy and safety of percutaneous coronary intervention (PCI) versus the optimal drug therapy (ODT) for stable coronary heart disease: a systematic review and meta-analysis.
BACKGROUND
Many studies have reported potential benefits of percutaneous coronary intervention (PCI) versus optimal drug therapy (ODT) for patients with stable coronary heart disease but with inconsistent results. To examine this, an explicit systematic review and meta-analysis was conducted to compared the clinical outcomes of PCI and ODT in these patients.
METHODS
The following terms were combined to search relative articles through databases PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science published from January 2010 to November 2021 according to Participants, Intervention, Control, Outcomes, Study (PICOS) criteria: "coronary heart disease", "stable coronary heart disease", "stable angina pectoris", "percutaneous coronary intervention", "PCI", "percutaneous transluminal coronary angioplasty", "drug therapy", "optimized drug treatment", and "optimized drug therapy". The meta-analysis was performed by RevMan 5.2, and the Cochrane risk of bias tool was used to evaluate the quality of the included studies.
RESULTS
A total of 12 articles were included in the final analysis. There were 4,288 cases of PCI patients and 4,261 cases of ODT patients. The results showed that, when comparing PCI with ODT, there was a significant difference in the probability of myocardial infarction [relative risk (RR) =0.63; 95% confidence intervals (CI): 0.45-0.90] and the patient mortality (RR =0.51; 95% CI: 0.40-0.64). However, there was no significant difference in the prevalence of stroke (RR =1.33; 95% CI: 0.82-2.17), revascularization (RR =0.86; 95% CI: 0.46-1.62) and patient quality of life (MD =10.44; 95% CI: -1.84 to 22.73). Performance bias and detection bias were all unclear in the included studies and should be warned.
DISCUSSION
Compared with ODT, PCI reduced the mortality and myocardial infarction rate of patients with CTO or severe coronary artery stenosis. However, the incidence of stroke, revascularization, and quality of life of patients were not significant different between PCI and ODT. Performance bias and detection bias should be cautioned.
PubMed: 35572911
DOI: 10.21037/jtd-22-222 -
BMC Cardiovascular Disorders May 2022Some patients with chronic coronary syndromes undergo invasive procedures but the efficacy of such interventions remains to be robustly established by randomised... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Some patients with chronic coronary syndromes undergo invasive procedures but the efficacy of such interventions remains to be robustly established by randomised sham-controlled trials (RCTs).
PURPOSE
To determine the sham effect in patients with chronic coronary syndromes enrolled in RCTs by performing a systematic review and meta-analysis.
METHODS
In April 2022, we performed a literature search for published patient-blind RCTs (CENTRAL, MEDLINE®, PsycINFO, and reference lists) with sham procedures, reporting the pre-post effects in the invasive sham arm among patients with Canadian cardiovascular society (CCS) angina or angina equivalents.
RESULTS
16 RCTs were included with 546 patients in the sham arm. Pooled results showed that sham interventions were associated with: improvement of 7% (95% CI 2-11%; I = 0%) in exercise time; decrease of 0.78 (95% CI - 1.10 to - 0.47; I = 75%) in CCS angina class; decrease of 53% (95% CI 24-71%; I = 96%) and 25% (95% CI 20-29%; I = 0%) in anginal episodes and nitroglycerine (NTG) use, respectively. Pooled results also showed an improvement in the physical functioning, angina frequency, treatment satisfaction, and disease perception domains of the Seattle Angina Questionnaire (SAQ).
CONCLUSION
Sham interventions in patients with chronic coronary syndromes were associated with a significant decrease in anginal episodes, NTG use, and CCS angina class and increased SAQ quality of life and exercise time. These results highlight the need for previous non sham-controlled trials to be interpreted with caution, and the importance of new invasive interventions to be evaluated versus a sham procedure.
Topics: Angina Pectoris; Canada; Coronary Artery Disease; Humans; Placebos; Quality of Life; Randomized Controlled Trials as Topic; Syndrome
PubMed: 35568808
DOI: 10.1186/s12872-022-02658-x -
Journal of the American Heart... Apr 2022Background A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary... (Meta-Analysis)
Meta-Analysis Review
Background A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary arteries. However, the prevalence of coronary microvascular disease (CMD) and coronary spasm in patients with nonobstructive coronary artery disease remains to be determined. The objective of this study was to determine the prevalence of coronary CMD and coronary vasospastic angina in patients with no obstructive coronary artery disease. Methods and Results A systematic review and meta-analysis of studies assessing the prevalence of CMD and vasospastic angina in patients with no obstructive coronary artery disease was performed. Random-effects models were used to determine the prevalence of these 2 disease entities. Fifty-six studies comprising 14 427 patients were included. The pooled prevalence of CMD was 0.41 (95% CI, 0.36-0.47), epicardial vasospasm 0.40 (95% CI, 0.34-0.46) and microvascular spasm 24% (95% CI, 0.21-0.28). The prevalence of combined CMD and vasospastic angina was 0.23 (95% CI, 0.17-0.31). Female patients had a higher risk of presenting with CMD compared with male patients (risk ratio, 1.45 [95% CI, 1.11-1.90]). CMD prevalence was similar when assessed using noninvasive or invasive diagnostic methods. Conclusions In patients with no obstructive coronary artery disease, approximately half of the cases were reported to have CMD and/or coronary spasm. CMD was more prevalent among female patients. Greater awareness among physicians of ischemia with no obstructive coronary arteries is urgently needed for accurate diagnosis and patient-tailored management.
Topics: Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Coronary Vessels; Female; Humans; Male; Microcirculation; Microvascular Angina; Prevalence
PubMed: 35301851
DOI: 10.1161/JAHA.121.023207