Comparative efficacy of Chinese herbal injections in patients with cardiogenic shock (CS): a systematic review and...

Area of Science:

• Cardiology
• Pharmacology
• Integrative Medicine

Background:

• Cardiogenic shock (CS) is a critical complication of acute myocardial infarction, leading to high mortality.
• Chinese herbal injections (CHIs) are increasingly utilized in China as a therapeutic option for CS.
• Optimal CHI selection for CS treatment requires further investigation.

Purpose of the Study:

• To compare the efficacy and safety of various CHIs when used as adjunct therapy to Western medicine (WM) for CS.
• To identify the most effective CHI for improving patient outcomes in CS.
• To rank CHIs based on their impact on mortality and hemodynamic parameters.

Main Methods:

• A Bayesian network meta-analysis (NMA) was performed on data from 43 randomized controlled trials (RCTs) involving 2,707 participants.
• Six CHIs were evaluated: Shenfu injection (SF), Shengmai injection (SM), Shenmai injection (Sm), Danshen injection (DS), Huangqi injection (HQ), and Xinmailong injection (XML).
• Interventions were ranked using Surface Under the Cumulative Ranking Curve (SUCRA) probabilities; clustering analysis was used for outcome comparison.

Main Results:

• Shenmai injection (Sm) and Shenfu injection (SF) showed superior efficacy over WM alone in reducing in-hospital mortality.
• Sm + WM ranked highest for in-hospital mortality, cardiac index (CI), and hourly urine output, and second for left ventricular ejection fraction (LVEF) and mean arterial pressure (MAP).
• SF + WM demonstrated the highest clinical effective rate, while SM + WM led in improving MAP. Adverse drug reactions were reported in 31.8% of studies across five CHIs.

Conclusions:

• The combination of CHIs and WM offers significant advantages over WM alone for patients with CS.
• Shenmai injection (Sm) emerged as a highly effective CHI, excelling in reducing mortality and improving multiple hemodynamic outcomes.
• Further research into the safety profiles and optimal application of CHIs in CS management is warranted.