A Prospective Cohort Study on the Risk of Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease after Percutaneous Coronary Intervention with Blood-invigorating and Stasis-dissolving Medicinals
Objective To explore the impact of blood-invigorating and stasis-dissolving medicinals combined with conventional western medicine on the major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A prospective cohort study was conducted to collect data on consecutive cases of CHD after PCI.According to whether blood-invigorating and stasis-dissolving medicinals were used,the cases were divided into a Chinese herbal medicinals(CHM)group and control group.The primary outcome was the incidence of MACE one year after PCI,while the secondary outcomes included TCM syn-drome score and echocardiography left ventricular ejection fraction(LVEF).Logistic regression analysis was per-formed to explore the influencing factors of MACE.Results A total of 844 patients who met the criteria were included,with 617 in the CHM group and 227 in the control group.The main blood-invigorating and stasis-dissolving medicinals being used were Danshen(Radix et Rhizoma Salviae Miltiorrhizae,46.35％),Chuanxiong(Rhizoma Chuanxiong,45.87％),and Chishao(Radix Paeoniae Rubra,42.30％).After a median follow-up of 12.73 months,the incidence of MACE in the CHM group(142/617,23.01％)was significantly lower than that in the control group(68/227,29.96％)with significant difference(OR=0.70,95％CI 0.50 to 0.98,P=0.04).The LVEF of the CHM group[(60.06±6.13)％]was higher than that of the control group[(58.27±7.36)％]with significant difference(t=0.356,P＜0.01).The TCM syndrome score in the CHM group decreased to 12.66±4.47,while that in the control group increased to 13.81±3.88,with the results favoring the CHM group(t=2.78,P＜0.01).Univariate analysis showed correlations between the incidence of MACE after PCI and the use of blood-invigorating and stasis-dissolving medicinals,LVEF,usage of renin-angiotensin-aldosterone system(RAAS)inhibitors,TCM syndrome score,and usage of β blockers(P＜0.05).Multivariate analysis showed that the use of blood-invigorating and stasis-dissolving medicinals was significantly associated with the reduction of MACE(P＜0.01),while the baseline LVEF decline,TCM syndrome score increase,no use of RAAS inhibitors or β blockers were the risk factors of MACE after PCI(P＜0.05).Conclusion The use of blood-invigorating and stasis-dissolving medicinals based on the conventional western medicine can reduce the risk of MACE one year after PCI of CHD,improve the TCM syndromes and protect heart function.
coronary heart diseaseblood-invigorating and stasis-dissolving medicinalspost-percutaneous coronary interventionmajor cardiovascular events
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