Efficacy and safety of different traditional Chinese medicine injections in the treatment of unstable angina pectoris: a systematic review and Bayesian network meta-analysis

Objectives Several studies have explored the efficacy and safety of various traditional Chinese medicine (TCM) injections for unstable angina pectoris. However, comprehensive systematic evidence confirming the advantages of these injections is still lacking. This Bayesian network meta-analysis was carried out to evaluate and compare the efficacy of different TCM injections in treating unstable angina pectoris. Methods A systematic search was implemented across PubMed, Cochrane Library, Embase, and Web of Science, with the date of search cutoff being February 2024. The Cochrane risk of bias tool was utilized to evaluate the bias risk in the included studies. Results A total of 44 studies, encompassing 4,362 patients with unstable angina pectoris and 21 types of injections, were included. Compared with the standard treatment group, Danhong injection (SMD = −1.1, 95% CrI: -2.0, −0.15), Danshen Chuanxiongqin injection (SMD = −1.9, 95% CrI: -3.7, −0.12), Ginkgo Damole injection (SMD = −2.5, 95% CrI: -4.8, −0.29), Puerarin injection (SMD = −1.8, 95% CrI: -3.2, −0.37), and Shuxuetong injection (SMD = −7.8, 95% CrI: -13, −2.3) were found to significantly reduce the frequency of angina attacks. However, no significant improvement was observed in the duration of angina episodes with any of the included TCM injections compared with the standard treatment group. There was no significant difference in the incidence of adverse events from TCM injections. Conclusion Adjunctive treatment with TCM injections, in addition to conventional therapy, can remarkably reduce the frequency of angina attacks and demonstrates a favorable safety profile. However, it does not appear to significantly reduce the duration of angina episodes. Future studies should include more multicenter populations to validate our conclusions, as the population included in this study was predominantly Chinese. Systematic Review Registration identifier [CRD42024501984].