A combination of Chinese herbs and western medicine is best for cardiogenic shock

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Background: Cardiogenic shock (CS) is the primary cause of death in patients suffering acute myocardial infarction. As an emerging and efficacious therapeutic approach, Chinese herbal injections (CHIs) are gaining significant popularity in China. However, the optimal CHIs for treating cardiogenic shock remain uncertain. 

Method: We searched eight databases from inception to 30 September 2023. Subsequently, we conducted the Bayesian network meta-analysis (NMA). Interventions were ranked based on the surface under the cumulative ranking curve (SUCRA) probability values. To compare the effects of Chinese herbal injections on two distinct outcomes, a clustering analysis was performed. Furthermore, the quality of the studies was assessed. 

Results: For the study, we included 43 RCTs, encompassing 2,707 participants. The study evaluated six herbal injections, namely, Shenfu injection (SF), Shengmai injection (SM), Shenmai injection (Sm), Danshen injection (DS), Huangqi injection (HQ), and Xinmailong injection (XML). The analysis findings suggested that Sm (MD = -1.05, 95% CI: -2.10, -0.09) and SF (MD = -0.81, 95% CI: -1.40, -0.25) showed better efficacy compared to Western medicine (WM) alone in reducing in-hospital mortality.

The SUCRA values revealed that Sm + western medicine ranked first in terms of in-hospital mortality, cardiac index (CI), and hourly urine output but second in improving left ventricular ejection fraction (LVEF) and mean arterial pressure (MAP). Shenfu injection + western medicine, however, had the greatest impact on raising the clinical effective rate. In MAP, Shenmai injection + western medicine came out on top. Moreover, in terms of safety, only 14 studies (31.8%), including five types of Chinese herbal injections: Shenfu injection, Shengmai injection, Shenmai injection, Huangqi injection, and Xinmailong injection, observed adverse drug reactions. 

Conclusion: To summarise, this analysis discovered that, in terms of patients suffering from cardiogenic shock, Chinese herbal injections + western medicine yielded significantly greater advantages than western medicine alone. Based on in-hospital mortality and the remaining outcomes, Shenmai injection performed excellently among all the involved Chinese herbal injections.

Reference: https://pubmed.ncbi.nlm.nih.gov/38476325/