Efficacy and safety of Traditional Chinese Medicine injections for no-reflow or slow flow in patients with acute coronary syndrome after percutaneous coronary intervention: a systematic review and network meta-analysis

Introduction: : There is a possibility of ischemia-reperfusion injury following percutaneous coronary intervention (PCI). Traditional Chinese medicine (TCM) treatment features multi-target and multi-link interventions, along with relatively good safety profiles, making it a promising option for alleviating ischemia-reperfusion injury following PCI. Methods: We searched the China National Knowledge Infrastructure (CNKI), VIP Journal Database, China Biomedical Literature Database, Wanfang Medical Database, PubMed, Web of Science, Embase, and Cochrane Library for randomized controlled trials published in Chinese and English regarding Chinese herbal injections for treating no-reflow or slow-reflow after PCI, from database inception to November 30, 2024. Results: A total of 14 interventions were evaluated, involving 5,535 patients. The interventions encompassed 14 types, including Shenfu Injection, Ginseng Injection, Shengmai Injection, Tanshinone IIA Sodium Sulfonate Injection, Danhong Injection, Danshen Injection, Shuxuetong Injection, Tanshinone Injection, Salvianolate Lyophilized Injection, Xuesaitong Injection, Salvia Ligustrazine Injection, Ixeris Sonchifolia Injection, Ginkgo Damo Injection, and standard treatment. The results indicated that the combination of salvianolate lyophilized injection with standard treatment might provide the best efficacy in improving no-reflow or slow blood flow after PCI. For enhancing Left Ventricular Ejection Fraction (LVEF) and reducing Left Ventricular End-Diastolic Dimension (LVEDD), the effect of Danshen Injection combined with standard Western medicine treatment was the most significant. Regarding reducing Left Ventricular End-Systolic Diameter (LVESD) and decreasing the incidence of Major Adverse Cardiovascular Events (MACE), Shenfu Injection showed possibly the most ideal effect. Meanwhile, Danhong Injection combined with standard treatment significantly improved the incidence of no-reflow compared to standard treatment, while also exhibiting positive effects on LVEF, reducing LVESD, and effectively decreasing the occurrence of MACE. Conclusion: Traditional Chinese Medicine (TCM) injections demonstrate significant efficacy and a favorable safety profile in treating no-reflow or slow blood flow after PCI in patients with acute coronary syndrome. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497449, PROSPERO CRD42024497449.