Meta-analysis and trial sequential analysis of shexiang baoxin pill for coronary slow flow.

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).