Title : Chinese herbal medicine effectively improves the composite outcome of repeat revascularization and in-stent restenosis in chronic coronary syndromes patients undergoing percutaneous coronary intervention
Abstract:
Background: Chinese herbal medicines (CHM) are gaining attention as complementary and alternative therapies for cardiovascular diseases. This study aims to explore the efficacy and favorable population of CHM in reducing the risk of major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI).
Methods: A prospective cohort study was conducted using cumulative CHM intake >6 months/year as the exposure factor, with the control group receiving Western medicine alone. Data were obtained from patients with CCS undergoing PCI between September 2016 and August 2017 at Fuwai Hospital. The primary endpoint was MACE, including repeat revascularization and in-stent restenosis (ISR). Kaplan-Meier and multivariate COX models were used to analyse the association between CHM and the risk of MACE.
Results: This study enrolled 2274 participants, comprising 1155 controls (median age 58 years [IQR 52.0, 64.0]; 78.3% male) and 1119 receiving integrative Chinese and Western medicine (ICWM; median age 59 years [IQR 52.0, 66.0]; 77.1% male). MACE occurred in 1054 patients, with significantly lower incidence in the ICWM group versus controls (42.8% [479/1119] vs 49.8% [575/1155]). ICWM intervention substantially reduced risks of MACE, repeat revascularization, and ISR (Log-rank test, P<0.001; P=0.0018; P=0.023). After adjusting for age, sex, body mass index, cigarette smoking, estimated glomerular filtration rate, hypersensitive c-reactive protein, prior PCI, presence of peripheral arterial disease, target lesion≥20 mm, number of stents, compared with the control group, patients in the ICWM group had a 21.30% lower risk of MACE (95%CI: 0.696-0.891; P<0.001) and a 17.0% lower risk of repeat revascularization (95%CI: 0.730-0.942; P=0.004), with no significant difference in the risk of ISR (P=0.071). For the risk of MACE, there was an interaction of treatment strategy with prior PCI (P=0.003) and multivessel coronary artery disease (CAD) (P<0.001). Patients with prior PCI receiving ICWM showed 40% lower MACE risk than the GDMT group (95% CI=0.49-0.74, P<0.001).
Conclusion: CHM is effective in reducing the risk of composite events of repeat revascularization and ISR in patients with CCS after PCI, and those with prior PCI and without multivessel CAD benefit more significantly.
