Yan Si-Yu, Yang Wei-Xian, Lu Pei-Pei, Guo Xuan-Tong, Guo Cai-Xia, Su Yan-Ni, Ma Li-Hong
Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China.
J Geriatr Cardiol. 2022 Sep 28;19(9):696-704. doi: 10.11909/j.issn.1671-5411.2022.09.005.
Chinese herbal medicine is widely used as a complement or alternative treatment in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in China. We compared the incidence of the major adverse cardiovascular event (MACE) of CAD patients with or without the complement use of Chinese herbal medicine after PCI.
In this prospective, observational study that was conducted from September 2016 to August 2019 in Fuwai Hospital (China), we followed up consecutive patients who received PCI treatment for two years. MACE was defined as the composite all-cause mortality, revascularization, and myocardial infarction (MI) and was compared between those using (integrative medicine group) or those not using Chinese herbal medicine as an additional treatment to standard Western medicine, with unadjusted (Kaplan-Meier curves) and risk-adjusted (multivariable Cox regression) analyses.
A total of 5942 patients after PCI were enrolled in this study, and 5453 patients were included in the final analysis (4189 [76.8%] male; mean age: 61.9 ± 9.9% years). During the follow-ups, 2932 (53.8%) patients used only Western medicine while 2521(46.2%) patients had used Chinese herbal medicine as an additional treatment to standard Western medicine. Patients in the integrative medicine group (IM group) were older than the Western medicine group (WM group), had more females and less previous MI. The incidence of MACE was 15.3% (449/2932) in WM group and 11.54% (291/2521) in IM group. Cox regression analysis showed that cumulative incidence of MACE was 27% lower in patients of the IM group than those in WM group (hazard ratio = 0.73; 95% CI: 0.63-0.85; < 0.0001).
For CAD patients after PCI treatment, complement use of Chinese herbal medicine is associated with a lower 2-year MACE incidence. Randomized prospective studies are warranted to provide higher levels of benefit evidence in these patients.
在中国，中药被广泛用作冠状动脉疾病（CAD）患者经皮冠状动脉介入治疗（PCI）后的补充或替代治疗。我们比较了PCI后使用或未使用中药补充治疗的CAD患者主要不良心血管事件（MACE）的发生率。
在2016年9月至2019年8月于中国阜外医院进行的这项前瞻性观察性研究中，我们对连续接受PCI治疗的患者进行了两年的随访。MACE被定义为全因死亡率、血运重建和心肌梗死（MI）的综合指标，并在使用中药（中西医结合组）或未使用中药作为标准西医附加治疗的患者之间进行比较，采用未调整（Kaplan-Meier曲线）和风险调整（多变量Cox回归）分析。
本研究共纳入5942例PCI术后患者，最终分析纳入5453例患者（男性4189例[76.8%]；平均年龄：61.9±9.9岁）。随访期间，2932例（53.8%）患者仅使用西药，2521例（46.2%）患者使用中药作为标准西药的附加治疗。中西医结合组（IM组）患者比西药组（WM组）患者年龄更大，女性更多，既往MI更少。WM组MACE发生率为15.3%（449/2932），IM组为11.54%（291/2521）。Cox回归分析显示，IM组患者MACE的累积发生率比WM组低27%（风险比=0.73；95%CI：0.63-0.85；P<0.0001）。
对于PCI术后的CAD患者，补充使用中药与较低的2年MACE发生率相关。有必要进行随机前瞻性研究，为这些患者提供更高水平的获益证据。
