Comparative efficacy of commercial Chinese polyherbal preparation for coronary microvascular dysfunction: a systematic review and network meta-analysis of randomized controlled trials

Wujiao Wang^1,2Yudou Li¹Xinyue Wang¹Pu Fenglan¹Zhifei Yang¹Yuxuan Li¹Jie Wan¹Peifen Chang^2*Tianli Li^3*

• ¹Beijing University of Chinese Medicine, Beijing, China
• ²Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
• ³China-Japan Friendship Hospital, Beijing, China

Background: Commercial Chinese polyherbal preparations (CCPPs) are widely used in China to treat coronary microvascular dysfunction (CMD). This network meta-analysis (NMA) aimed to evaluate and rank the relative efficacy of CCPPs for CMD and summarize the possible mechanisms according to experimental researches. Method: From the time the database was established to 12 December 2024, We systematically searched eight databases and two registry systems. Clinical randomized controlled trials (RCTs) of nine CCPPs in treating CMD were retrieved. The primary outcomes were the Index of Microcirculatory Resistance (IMR) and Coronary Flow Reserve (CFR). Secondary outcomes included the Angina attack frequency, hypersensitive C-reactive protein (hs-CRP), Endothelin-1 (ET-1), Nitric oxide (NO), and Low-density lipoprotein cholesterol (LDL-C). Two researchers performed rigorous data extraction and quality assessment. The quality of the included RCTs was evaluated using the Cochrane Risk of Bias assessment tool. Interventions were ranked based on the surface under the cumulative ranking curve (SUCRA) probability values. The risk of bias was detected using funnel plots and Egger's test. Result: A total of 39 RCTs involving 3240 patients were included in this study. NMA results showed that SXBX had the highest probability of being the best treatment on account of the reduction of IMR (MD = -5.93, 95% CI [-8.75, -3.11] ) and LDL-C (MD = -0.56, 95% CI [-0.99, -0.14] ), XB showed better efficacy in improving CFR ( MD = 0.71, 95% CI [ 0.53, 0.89] ), TXL showed better efficacy in angina attack frequency (MD = -5.30, 95% CI [-7.08, -3.53] ); YXTL showed better efficacy in hs-CRP (MD = -5.04, 95% CI [-8.38, -1.7] ); XKS showed better efficacy in ET-1 (MD = -43.3, 95% CI [-59.71, -26.89]; YDXNT showed better efficacy in NO (MD =17.69, 95% CI [6.07, 29.32] ). Conclusion: SXBX emerged as the optimal treatment regimen for lowering IMR and LDL-C levels. Additionally, XB demonstrated superiority in improving CFR. TXL demonstrated superiority in reducing angina attack frequency, YXTL in lowering hs-CRP levels, XKS in lowering ET-1 levels, and YDXNT in increasing NO levels.