title: Tong-xin-luo capsule for patients with coronary heart disease after percutaneous coronary intervention.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is a standard treatment for coronary heart disease (CHD). Restenosis, defined as a 50% reduction in luminal diameter at six months after PCI, indicates a need for revascularisation. Restenosis has proven to be a major drawback to PCI. Tong-xin-luo is one of the prophylactic strategies for cardiovascular events in patients after PCI that is widely used in China, but its efficacy and safety have not been systematically evaluated.
  
  
  OBJECTIVE
  To systematically assess the efficacy and safety of Tong-xin-luo capsules in preventing cardiovascular events after PCI in patients with CHD.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE (OVID), EMBASE (OVID), WanFang, Chinese Biomedical Database, Chinese Medical Current Contents, and China National Knowledge Infrastructure from their inception to June 2014. We also searched other resources, including ongoing trials and research registries. We applied no language restrictions.
  
  
  METHODS
  Randomised controlled trials of participants with CHD after PCI were included. Participants in the intervention group received Tong-xin-luo capsules for at least three months.
  
  
  METHODS
  Two review authors independently extracted data and assessed the risk of bias. Any disagreements were resolved by discussion with a third review author. The primary outcomes included occurrence of angiographic restenosis and adverse events; the secondary outcomes included myocardial infarction, heart failure, angina, all cause mortality, mortality due to any cardiovascular event, use of revascularisation, patient acceptability, quality of life and cost-effectiveness. Dichotomous data were measured with risk ratios (RRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Sixteen studies involving 1063 participants were identified. The risk of bias for fifteen studies was high and along with imprecision and possible publication bias, this lowered our confidence in the results. There was low quality evidence that Tong-xi-luo reduced the rates of angiographic restenosis (RR 0.16, 95% CI 0.07 to 0.34), myocardial infarction (RR 0.32, 95% CI 0.16 to 0.66), heart failure (RR 0.26, 95% CI 0.11 to 0.62), and use of revascularisation (RR 0.26, 95% CI 0.15 to 0.45). There was very low quality evidence for the effect of Tong-xin-luo on all-cause mortality (RR 0.38, 95% CI 0.06 to 2.56), angina (RR 0.24, 95% CI 0.17 to 0.34) and death due to any cardiovascular event (RR 0.31, 95% CI 0.08 to 1.12). Adverse events were seldom reported, and included gastrointestinal reactions and nausea.
  
  
  CONCLUSIONS
  The addition of Tong-xin-luo to conventional Western medicine may possibly prevent restenosis and recurrence of cardiovascular events in patients with CHD after PCI. However, the data are limited by publication bias and high risk of bias for included studies. Further high-quality trials are required to evaluate the potential effects of this intervention.
authors.affiliation: Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Mao
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Fu
authors.forename: Jin-Qiu
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Zu-Yao
authors.initials: ZY
authors.lastname: Yang
authors.forename: Vincent C H
authors.initials: VC
authors.lastname: Chung
authors.forename: Ying
authors.initials: Y
authors.lastname: Qin
authors.forename: Yafang
authors.initials: Y
authors.lastname: Huang
authors.forename: Wilson Wai San
authors.initials: WW
authors.lastname: Tam
authors.forename: Joey S W
authors.initials: JS
authors.lastname: Kwong
authors.forename: Wei
authors.initials: W
authors.lastname: Xie
authors.forename: Jin-Ling
authors.initials: JL
authors.lastname: Tang
mesh_terms: D000787:Angina Pectoris / Q000517:prevention & control; D002214:Capsules; D002423:Cause of Death; D003327:Coronary Disease / Q000188:drug therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D002214:Capsules; D004365:Drugs, Chinese Herbal; C513941:tongxinluo