Shexiang Baoxin Pill for Acute Myocardial Infarction: Clinical Evidence and Molecular Mechanism of Antioxidative Stress

Abstract

Acute myocardial infarction (AMI) has been a preclinical and clinical concern due to high hospitalization rate and mortality. This study was aimed at evaluating the effectiveness and safety of Shexiang Baoxin Pill (SBP) for AMI and exploring the possible mechanism of oxidative stress. Six databases were searched on March 26, 2021. Twenty-four studies were included and accessed by the RoB 2.0 or SYRCLE tool. Compared with routine treatment (RT), SBP showed the effectiveness in the clinical efficacy ( $\text{RR}=1.15$ , 95% CI [1.06, 1.25]), left ventricular ejection fraction (LVEF) ( $\text{SMD}=0.73$ , 95% CI [0.62, 0.95]), glutathione (GSH) ( $\text{SMD}=2.07$ , 95% CI [1.51, 2.64]), superoxide dismutase (SOD) ( $\text{SMD}=0.92$ , 95% CI [0.58, 1.26]), malondialdehyde (MDA) ( $\text{SMD}=-4.23$ , 95% CI [-5.80, -2.66]), creatine kinase-myocardial band (CK-MB) ( $\text{SMD}=-4.98$ , 95% CI [-5.64, -4.33]), cardiac troponin I (cTnI) ( $\text{SMD}=-2.17$ , 95% CI [-2.57, -1.76]), high-sensitivity C-reactive protein (Hs-CRP) ( $\text{SMD}=-1.34$ , 95% CI [-1.56, -1.12]), interleukin-6 (IL-6) ( $\text{SMD}=-0.99$ , 95% CI [-1.26, -0.71]), triglycerides (TG) ( $\text{SMD}=-0.52$ , 95% CI [-0.83, -0.22]), flow-mediated dilation (FMD) ( $\text{SMD}=1.39$ , 95% CI [1.06, 1.72]), von Willebrand Factor (vWF) ( $\text{SMD}=-1.77$ , 95% CI [-2.39, -1.15]), nitric oxide (NO) ( $\text{SMD}=0.89$ , 95% CI [0.65, 1.13]), and recurrent rate ( $\text{RR}=0.30$ , 95% CI [0.15, 0.59]). But SBP adjunctive to RT plus PCI had no improvements in almost pooled outcomes except for the Hs-CRP ( $\text{SMD}=-1.19$ , 95% CI [-1.44, -0.94]) and TG ( $\text{SMD}=-0.25$ , 95% CI [-0.48, -0.02]). Laboratory findings showed that SBP enhanced the endothelial nitric oxide synthase (eNOS) activity and regulated laboratory indexes especially for homocysteine. In conclusion, SBP has adjunctive effects on AMI via the mechanism of antioxidative stress. The current evidence supports the use of SBP for mild and moderate AMI patients.