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Journal of Traditional Chinese Medicine, December 2011; 31(4): 269-272 269

Reviews
Characteristics and Advantages of Traditional Chinese Medicine in the
Treatment of Acute Myocardial Infarction
LIU Hong-xu [-
1
, WANG Shuo-ren (
2
, LEI Yan ,
3
, and SHANG Ju-ju
1
Objective: To obtain epidemiological data on Traditional Chinese Medicine (TCM) therapeutic status of acute
myocardial infarction (AMI) and to determine TCM characteristics and advantages to improve the level of TCM
prevention and treatment of AMI.
Methods: Clinical epidemiology methods were used to register and survey the TCM therapeutic status of
hospitalized AMI patients. In 2001, the Chinese Association of Integrative Medicine surveyed the therapeutic status
of 3308 AMI patients hospitalized in 30 hospitals in Beijing and Shanghai from 20002001. The Beijing
Collaborative Study Group on Therapeutic Status of Acute Myocardial Infarction (the Study Group) then conducted
a 10-year-long register survey on hospitalized AMI patients in Third-grade A-Level TCM hospitals in Beijing. After
2002, the Study Group further surveyed the treatment conditions of AMI-hospitalized patients in 10 Second-grade
A-Level TCM hospitals. The therapeutic status in 8 Third-grade A-Level Western medicine hospitals was surveyed
in 2001 and 2005 as a control. In 2008, in cooperation with the China Association of Chinese Medicine, the Study
Group further performed a survey at 26 Third-grade A-Level TCM hospitals nation-wide. Approximately 5000
cases were investigated to obtain authoritative data on the therapeutic status of AMI patients in TCM hospitals in
China.
Results: We found that Chinese herbal intravenous preparations may be beneficial in reducing the mortality of AMI.
Major complications of AMI, such as heart failure and arrhythmia, were significantly less during the 10-year survey
period. The mortality of hospitalized AMI patients showed a decline. TCM treatment was helpful for AMI patients
in improving their quality of life. Ten-year dynamic monitoring showed that the ability to perform reperfusion and
to use drugs appropriately, as well as an effort to carry out the Clinical Guidelines has made great progress in TCM
hospitals. However, TCM hospitals still have some problems in treating AMI, including a lack of standardized TCM
syndrome diagnosis, the need for syndrome differentiation and treatment standardization, and clinical skills in
reperfusion and standardized drug treatment still need to be further improved. Compared with AMI patients in
Western medicine hospitals during the same period, those in TCM hospitals had the following characteristics: they
were admitted to hospital later; they were older when they had a heart attack; there were more females, they had
more problems in their medical history, and they had more concomitant illnesses and complications. Therefore, the
demographic baseline data were significantly different between AMI patients in TCM hospitals and those in
Western medicine hospitals. This indicated that patients in TCM hospitals were more critical than those in Western
medicine hospitals.
Conclusions: TCM has special advantages in treating AMI. TCM hospitals are making continuous progress in
standardized treatment of AMI, but further improvement is still required. AMI patients in TCM hospitals have some
special characteristics, and their condition may be more critical. Further clinical research on TCM treatment of AMI
is required.
Keywords: acute myocardial infarction; Traditional Chinese Medicine; therapeutic status
With the process of aging, cardiovascular diseases have
become the leading cause of death. Acute myocardial
infarction (AMI) is the most common cardiovascular
intensive illness. Although cardiovascular diseases are
always the primary topic in the strategy for the
development of Chinese medicine, there are insufficient
epidemiological data on Chinese medicine treatment of
AMI in the past 60 years, and well designed clinical
studies on Chinese medicine treatment of AMI are also
rare.
From the early 1970s to early 1990s, in-hospital
mortality in AMI patients in Beijing gradually decreased
from 23.20% to 10.8%.
1-3
Surveys in Tianjin, Shanghai
and Guangzhou

showed that the mortality from AMI is

1. Beijing Traditional Chinese Medicine Hospital, Capital Medical
University, Beijing, China; 2. Dongzhimen Hospital, Beijing
University of Traditional Chinese Medicine, Beijing, China; 3.
China Academy of Chinese Medical Sciences, Beijing, China
Correspondence to: Prof. LIU Hong-xu. E-mail: LHX_@263.net
This study was financially supported by the Capital Research
Foundation for Medical Development, Beijing Medicine & Health
Science Collaborative Research Project (Grant No. 2001-I-04) and
Beijing Administration of Traditional Chinese Medicine
Professional Ethics 51510 Projects (Grant Nos. JJ-2006-56,
JJ2007-031).
Journal of Traditional Chinese Medicine, December 2011; 31(4): 269-272 270
between 12% and 20%.
4-6
Since 2000, several large-scale
clinical epidemiological surveys on coronary heart
disease have been launched in China, including the
Survey on the Treatment Status of AMI (STSAMI), the
Global Registry of Acute Coronary Events (GRACE),
the Clinical Pathways for Acute Coronary Syndrome in
China (CPACS) and Bridging the Gap on CAD
Secondary Prevention (BRIG). Each of these studies
investigated at least 3000 cases. STSAMI was the only
clinical epidemiological study on AMI.
7
STSAMI, which was initiated by the Chinese
Association of Integrative Medicine, Committee of
Cardiovascular Diseases, involved 3308 hospitalized
AMI cases in 30 hospitals in Beijing and Shanghai
during the period of 20002001.
8,9
The Beijing
Collaborative Study Group on Therapeutic Status of
Acute Myocardial Infarction (the Study Group) then
conducted a 10-year long register survey on hospitalized
AMI patients in Third-grade A-Level TCM hospitals in
the Beijing area. After 2002, the Study Group further
investigated the treatment conditions of AMI
hospitalized patients in 10 Second-grade A-Level TCM
hospitals. The therapeutic status in 8 Third-grade
A-Level Western medicine hospitals was surveyed in
2001 and 2005 as a control. In 2008, in cooperation with
the China Association of Chinese Medicine, the Study
Group further carried out a survey at 26 Third-grade
A-Level TCM hospitals nation-wide, and approximately
5000 cases were investigated. To date, the Study Group
has obtained the most authoritative data on the
therapeutic status of AMI patients in TCM hospitals in
China. The related survey results will be published
gradually. Preliminary survey results showed that TCM
has special advantages in treating AMI, and TCM
hospitals have made continuous progress in the treatment
standardization for AMI, but there are still some
problems. It was also found that AMI patients in TCM
hospitals have some special characteristics.
TCM has particular advantages in treating AMI
Mortality is a strong end point in clinical studies on
cardiovascular diseases. Our survey showed that Chinese
herbal intravenous preparations may be beneficial in
reducing the mortality of AMI. Results from a logistic
multiple regression analysis on mortality in 12 TCM or
Western medicine hospitals in 2000 showed that TCM
intravenous preparations ranked as the third contributor
in reducing mortality.
8
Surveys on both 1390 in-hospital
AMI patients from 16 Second-grade or Third-grade TCM
hospitals in 20022005 and 1663 hospitalized AMI
patients from 13 Third-grade A-Level TCM hospitals or
Western medicine hospitals obtained the same results.
10,11
Logistics regression analysis on 10-year clinical data and
mortality of AMI patients from Third-grade A-Level
TCM hospitals in the Beijing area during 19992008
also showed that TCM intravenous preparations were
effective in lowering the mortality rate of AMI. Statistics
data on AMI in Third-grade A-Level TCM Hospitals in
Beijing showed that the major complications of AMI,
such as heart failure and arrhythmia, were significantly
less during these 10 years. The mortality of hospitalized
AMI patients showed a decline.
12
A single center clinical study on the treatment of AMI
with Danshen (Salvia miltiorrhiza) injectable powder in
the Beijing TCM Hospital showed that the total mortality
in the treatment group was lower than that in the control
group. This suggests that Danshen intravenous
preparations might be helpful for the prognosis of AMI
patients.
13
Data on 162 AMI patients in Dongfang
Hospital of Beijing University of Chinese Medicine was
evaluated by multi-factor analysis to determine various
factors of mortality. The results showed that both
angiotensin converting enzyme inhibitors (ACEI) and
TCM herbal soup were protective factors for long-term
prognosis of AMI patients.
14
A meta-analysis by our
group also showed that TCM intravenous preparations as
an adjuvant treatment was useful in reducing AMI
mortality.
15
This is similar to the results from a
retrospective study in Shanghai in the mid 1990s
16
and a
Chinese Cardiac Study (CCS-1).
17
A preliminary follow-up survey showed that TCM
treatment was beneficial to AMI patients for their quality
of life. A follow-up study on 115 AMI patients using the
World Health Organization Quality of Life BREF
(WHOQOL-BREF) showed that the scores of most
patients were between neither poor nor good/neither
satisfied nor dissatisfied and good in the physiological
domain, psychological domain, social relationship
domain, and environment domain. The total quality of
life scores was good (47%) or not bad (46%).
Additionally, the total health assessment scores were
satisfied (41%) and not dissatisfied (46%).
18
TCM hospitals have made continuous progress in the
treatment standardization for AMI
A survey in 2000 showed that reperfusion was used for
19.6% of AMI patients in Third-grade TCM hospitals in
the Beijing area, and thrombolytic therapy was applied
for all the reperfusion treatments. By 2005, up to 21.9%
of AMI patients in those hospitals used reperfusion
therapy, and more than 50% of the cases were treated
with interventional therapy. In 2000, no revascularization
procedures such as interventional therapy and coronary
artery bypass were conducted in TCM hospitals, but by
2005, 21.9% of cases received revascularization
treatment. Applications of angiotensin converting
enzyme inhibitors (ACEI), beta blockers and lipid
lowering drugs, as evidence-based treatments
recommended in the Clinical Guidelines for AMI,
increased greatly from 58%, 58% and 31% in 2000 to
77%, 66% and 57% in 2005, respectively.
8,11
Ten-year
dynamic monitoring showed that the ability to perform
reperfusion and to use drugs appropriately, as well as
making an effort to perform the Clinical Guidelines have
Journal of Traditional Chinese Medicine, December 2011; 31(4): 269-272 271
made great progress in Third-grade TCM hospitals in the
Beijing area. TCM intravenous preparations and
decoctions have also been widely used.
12
AMI treatment in TCM hospitals still needs to be
improved
The surveys also showed that TCM hospitals still had
some problems in treating AMI, including a lack of
standardized TCM syndrome diagnosis, a need for
syndrome differentiation, treatment standardization, and
clinical skills in reperfusion, and standardized drug
treatment still needs to be further improved.
A previous study on the regular pattern of TCM
syndromes found that there were 74 types of TCM
syndromes in 1124 AMI patients. Only 4 of those
syndromes appeared in more than 5% of the total cases.
There was no significant relationship between the
syndrome pattern and mortality. Therefore, many types
of syndromes being diagnosed indicates that there is a
lack in standardization of syndrome diagnosis.
19
An
investigation on what type of treatment was given for a
particular syndrome showed that 39% of AMI patients
with non-blood stasis syndrome were administrated with
TCM preparations that promoted blood circulation and
dissolving blood stasis. Additionally, 33% of patients
without Qi and Yin deficiency were prescribed Sheng
Mai Yin, an herbal preparation for deficiency of both Qi
and Yin. These differences in AMI TCM treatments
suggested that the treatment of AMI with various
syndromes also needs to be standardized.
20
Although
there has been some progress in treatment
standardization, reperfusion therapy used in TCM
hospitals is still less than that in Western medicine
hospitals. The use of drugs recommended by the AMI
Guidelines is still lower in TCM hospitals than that in
Western medicine hospitals.
8,11,21,22
AMI patients in TCM hospitals have particular
characteristics
Our survey showed that there was a high in-hospital
mortality rate in AMI patients in TCM hospitals in the
Beijing area. With continuous improvement in
reperfusion skill and standardized treatment, the
mortality of AMI has gradually decreased in TCM
hospitals. However, there is still a difference between
TCM hospitals and Western medicine hospitals. The
reason for this result needs to be determined. On the one
hand, it suggests that further efforts should be made in
TCM hospitals to improve the interventional therapeutic
skill and to normalize drug therapy following the
Clinical Guidelines. On the other hand, it suggests that
more attention should be paid to the independent clinical
characteristics of AMI patients in TCM hospitals. Further
extensive data analysis will hopefully provide some
answers.
Compared with AMI patients in Western medicine
hospitals during the same period, those in TCM hospitals
had the following characteristics: they were admitted to
hospital later; they were older when they had a heart
attack; there were more females, there were more
problems in their medical history, and they had more
concomitant illnesses and complications. This
demographic baseline data highlighted the differences
between AMI patients in TCM hospitals and in Western
medicine hospitals. Consequently, the therapeutic status
and prognosis were not the same in the 2 types of
hospitals. It is possible that there is a relationship
between these characteristics and the relatively high
mortality, less reperfusion treatment and fewer
applications of some drugs recommended by the
Clinical Guidelines in TCM hospitals. For example, in
2000 and 2005, the mean age of AMI patients was 61.4
vs 67.6 years old and 62.8 vs 69.1 years old in
Third-grade A-Level Western medicine hospitals and
their TCM counterpart hospitals in Beijing, respectively.
This finding indicated that patients in TCM hospitals
were more critical than those in Western medicine
hospitals. TCM hospitals have a heavier burden of social
health care. More resources and support from the
government should be provided to these
hospitals.
10-12,21-24
Since the end of the last century, the treatment of AMI
has focused on reperfusion, and there is a lot more
clinical evidence for drug therapy. The AMI Clinical
Guidelines form the basis for AMI standardized
treatment. Mortality from AMI has also shown a gradual
decrease. However, AMI is still a critical disease. We
urgently need to determine how to reduce in-hospital
AMI mortality. TCM treatment should be considered as
an important alternative method. The above survey
results suggest that Chinese medicine has potential
advantages in reducing mortality of AMI. However, AMI
patients in Chinese medicine hospitals have some
particular characteristics, and they may also have a more
critical condition than those in Western hospitals. In
addition, TCM hospitals are still not proficient in TCM
diagnosis and treatment standardization for AMI.
Therefore, to ensure that TCM therapy plays a better role
in the treatment of integrative Chinese and Western
medicine to reduce AMI mortality, clinical research on
TCM AMI treatment should be increased. With further
studies, more clinical evidence of TCM in the prevention
and treatment of major diseases could also be provided to
public health authorities and medical insurance systems.
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