Background
Description of the condition
Acute myocardial infarction (AMI) is due to the formation of an area of necrosis in heart muscle caused by inadequate supply of blood to the muscle, usually as a result of occlusion of a coronary artery (Burton 1996). After approximately 3 to 6 hours the area of necrotic cardiac muscle reaches its largest size. AMI can lead to death from complications due to cardiogenic shock, cardiac perforation - external or interventricular, embolism, heart failure, papillary muscle rupture, rhythm disturbances or autoimmune pericarditis (MVS 2002). AMI is the most common cause of morbidity from ischaemic heart disease and is the leading cause of death in the western world. Each year approximately 800,000 to 1.5 million people in the United States experience AMI, and about 213,000 of them die (MVS 2002, Herlitz 1989, NHLBI 1992). Accurate data on mortality and incidence of AMI in China are not available. Mortality from myocardial infarction varies according to the patient's sex and age. Younger women with AMI have higher 30-day case fatality than men (e.g. < 55 years, women 6.5% versus 4.8% men, P < 0.0001), and men are more likely to die before hospitalisation (McCann 2001). Currently myocardial infarction can be accurately diagnosed on the basis of clinical history and electrocardiographic (ECG) evidence. If the ECG evidence is unclear then alterations in cardiac enzymes, such as troponin, are used to aid diagnosis. Other cardiac enzymes besides troponins, are used in helping with the diagnosis, e.g. creatine kinase (CK) and CK-MB. Patients are usually admitted to hospital for acute treatment and monitoring, and the certainty of diagnosis of AMI is increased if cardiac enzyme levels show a rise over time. Typically, troponin levels are used with ECG evidence and clinical symptoms to make a diagnosis of AMI (Brooks 2001).
Treatments for the condition
Drug therapy for AMI includes thrombolytic therapy, aspirin for its antiplatelet properties and morphine for pain relief as needed. In addition to pharmacotherapy aimed at improving outcomes, supportive actions including admission to a cardiac care unit, 24˜36 hours of bed-rest, continuous ECG monitoring, and oxygen therapy are widely used. In some centres, percutaneous transcoronary angioplasty may be used as primary therapy (MVS 2002).
Danshen compound
Danshen, a Chinese herbal medicine, is widely used in China for treatment of several diseases, including AMI. The main component of danshen compound is the roots of the danshen plant (Latin name Salvia miltiorrhiza). Three other plants are typically also included with it, Crataegus laevigata (hawthorn), Coleus forskohlii (an Indian herb) and Valeriana officinalis (valerian). Various formaulations are shown in Table 1. Typically, danshen is used as one ingredient together with other herbs and water which is then boiled for several hours resulting in a herbal soup, which can be administered as an injection.
Salvia miltiorrhiza promotes blood circulation and relieves blood stasis (Bensky 1987). It also increases the activity of superoxide dismutase in platelets and inhibits platelet aggregation, thus providing protection against pulmonary embolism. Other effects include cholesterol lowering, reduction of endothelial damage, inhibition of lipid peroxidation, and inhibition of noradrenaline induced contraction of the aortic strips by reducing calcium ion mobilisation (Negard 1996; Wang 1996; Wu 1998). Of the other components, Crataegus laevigata lowers blood pressure but can lead to arrhythmia in the ischaemic myocardium (Garjani 2000); Valeriana officinalis is used as a sedative, lowers blood pressure and relieves angiospasm (BHMA 1983); and Coleus forskohlii inhibits platelet activation, increases the force of contraction of heart muscle and lowers blood pressure. The actions of Crataegus laevigata are thought to be enhanced by Salvia miltiorrhiza and Coleus forskohlii. The relaxing and stress reducing actions of Valeriana officinalis are thought to further enhance the overall effect of danshen compound.
Danshen compound has several functions:
1. dilation of the coronary arteries, increasing coronary arterial blood flow (Sang 1979; Zhen 1997);
2. increasing the deformability of white blood cell and reducing their adherence, thus improving the flow of blood (Liu 2006a) and protecting the cardiac muscle from ischaemia (Zhou 1991); and
3. constituent herbs act together to improve peripheral circulation and general well being. In addition, other herbs are sometimes used with danshen compound, for example huangqi ( Table 1).
Table 2 provides a glossary of some of the traditional Chinese herbs mentioned in throughout this review.
Reported side effects of danshen
We identified 840 reports about the side effects of danshen compound which include anaphylaxis and anaphylactic shock, stomach discomfort, loss of appetite, pruritus, low blood pressure, dizziness, headache and an increase in the risk of bleeding especially with excessive use. Bleeding may occur in the skin or mucous membranes or menorrhagia may occur. Increased in serum aminotransferase has also been reported (He 2006; Lu 2006; Zhen 1997; Xu 2006).
These herbs may also affect the action of other pharmacological agents: Salvia miltiorrhiza may exaggerate the anticoagulant effect of warfarin (Chan 2001) and Crataegus laevigata may act synergistically with digitalis, cardiac glycosides and hypotensive drugs. The dosage of medical drugs may need to be modified if used concurrently.
Up to now literally thousands of studies about the effects of danshen compound for AMI have been published, and many purport to show markedly beneficial effects of treatment. This is reflected in the fact that various danshen preparations have been widely used clinically. However, the quality of these studies and the results of clinical trials have not been systematically reviewed and assessed. Accordingly, this review aims to summarise the existing evidence concerning the comparative effects and safety of danshen preparations.
Objectives
To assess the effects (harms and benefits) of danshen compound preparations for AMI.
Methods
Criteria for considering studies for this review
Types of studies
Randomised controlled studies lasting at least 7 days were sought. In the event that few RCTs were available, it was our intention to also consider other controlled studies.
Types of participants
Participants were adult men and women of any age or ethnic origin with AMI. Diagnosis of AMI was defined as the presence of unequivocal ECG changes and/or unequivocal enzyme changes. The medical history could be typical or atypical.
Types of interventions
Danshen compound defined as preparations containing danshen, in various forms (e.g. injection, tablet, decoction) to be compared with:
- standard or usual care for acute myocardial infarction;
- usual pharmacotherapy;
- placebo; or
- other Chinese herbs.
We also included those trials in which danshen preparations were used as control.
Types of outcome measures
Primary outcome measure
1. Mortality: death from AMI within 30 days.
Secondary outcome measures
1. Deterioration or improvement in symptoms of angina (such as chest pain, breathlessness, reduction in strength, etc).
2. Recurrent myocardial infarction.
3. Quality of life.
4. Readmission to hospital or use of revascularisation.
Adverse event outcome measures
Any adverse event as a result of treatment, including:
- death;
- life-threatening reactions;
- toxic responses;
- anaphylaxis; or
- anything that resulted in discontinuation of treatment.
Search methods for identification of studies
Electronic searches
Searches were conducted to identify all published and unpublished randomised controlled trials (RCTs). Studies in any language were sought. Where necessary, non-English-language papers were translated so that they could be fully assessed for potential inclusion in the review.
Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to Dec., 2006), EMBASE (1980 - Dec., 2006) and the Chinese Biomedical Base, CBM (1982 - Dec., 2006). Search terms below were used for CENTRAL and adapted appropriately for other databases:
#1 DANSHEN
#2 (DAN next SHEN)
#3 SALVIA*
#4 SAGE
#5 (((#1 or #2) or #3) or #4)
#6 MYOCARDIAL-INFARCTION*:ME
#7 (MYOCARDIAL next INFARCT*)
#8 (ACUTE next CORONARY)
#9 (UNSTABLE near ANGINA)
#10 (HEART next ATTACK)
#11 (CORONARY near DISEASE)
#12 MYOCARDIAL-ISCHEMIA*:ME
#13 AMI
#14 (((((((#6 or #7) or #8) or #9) or #10) or #11) or #12) or #13)
#15 (#5 and #14)
Handsearches
We also searched the reference lists of relevant trials and identified reviews, and handsearched 75 Chinese traditional medicine Journals (listed in Table 3)
The International Standard Randomised Controlled Trial Number Register (ISRCTN) and ClinicalTrial.gov were also searched for ongoing trials.
Data collection and analysis
Trials selection
TW and NJ scanned the results of the search relevant records were identified. Full articles for all potentially relevant trials were retrieved. Since all the publications were in Chinese, TW and NJ were able independently to interview by telephone many of the original authors to identify what method was used to generate the allocation sequence. TW selected the trials for inclusion. All identified reports were scrutinised to check for multiple publications of the same trials.
Quality assessment of trials
We assessed the methodological quality of each trial in terms of generation of allocation sequence, allocation concealment, blinding, and loss to follow up. For each trial, we classified each quality component as 'adequate', 'inadequate', 'unclear' or 'not used' according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2006). After including all eligible studies in the primary analysis, we conducted sensitivity analyses for each of the quality factors using the subgroups adequate, inadequate, or unclear. There were no recorded disagreements between the three authors' assessments.
Data extraction
We independently extracted data. A data abstraction form was specifically designed for this review, and included the following items:
- General information: published/unpublished, title, authors, reference/source, contact address, country, urban/rural etc., language of publication, year of publication, duplicate publications, sponsor, setting.
- Trial characteristics: design, duration of follow up, method of randomisation, allocation concealment, blinding (patients, people administering treatment, outcome assessors).
- Intervention(s): intervention(s) (dose, route, timing), comparison intervention(s) (dose, route, timing), co-medication(s) (dose, route, timing).
- Patients: inclusion and exclusion criteria, total number, and number in comparison groups, age, baseline characteristics, diagnostic criteria, similarity of groups at baseline (including any co-morbidity), assessment of compliance, withdrawals/losses to follow up (reasons/description), subgroups.
- Outcomes: outcomes specified above, any other outcomes assessed, other events, length of follow up, quality of reporting of outcomes.
- Results: for outcomes and times of assessment (including a measure of variation), where necessary these were converted to measures of effect specified below, and intention-to-treat analysis applied.
We also obtained more information e.g. on method of randomisation, allocation concealment from the original authors by telephone interview.
Data analysis
We analysed mortality using Review Manager (version 4.2.9) to perform a limited pooled analyses for two studies (Chen 1984a and Chen 1984b), because no heterogeneity was detected we used a fixed-effect model to pool the data. We conducted subgroup analysis based on gender, prospective versus retrospective studies, and different interventions, respectively, we did not combine data due to only one study included in these subgroups. The effects were presented as Peto odds ratio (Peto OR) together with 95% confidence intervals.
Results
Description of studies
See: Characteristics of included studies; Characteristics of excluded studies.
Studies identified
The initial search yielded 269 records. After scanning the title and abstract, 49 of these appeared to be comparative studies of danshen preparations.
Excluded studies
Of the 49 published articles initially identified, 19 articles were excluded as they were not randomised controlled comparisons (Chen 1996; Cui 2004; Dong 2002; Han 1992; Li 2003; Liang 2001; Liu 1998; Liu 2006b; Luo 2001; Sun 1992; Sun 1997; Wang 1995; Wang 2000; Xu 2003; Yang 1997; Yuan 2003; Zhang 1999; Zhou 1996; Zhu 2000), seven articles were excluded as the outcome of interest was not reported (Cui 1983; Liang 1999, Shi 2000, Wang 2003; Wu 2005; Zhang 2001, Zhong 2000); four studies were excluded one of which had an unclear description of interventions in the text (CYG 1981) and the remaining three were multiple versions of that study (Chen 1987; Chen 1988; GAM 1984); eight studies* were excluded as their aims of studies were assessment of other remedies for which danshen preparations served as control (Cha 1998; Chen 2004; He 2000; Li 1995; Tang 1999; Wang 1999; Xie 2001; Ye 2006), and five studies were excluded because they studied other remedies combined with danshen preparations (Deng 1998; Liang 2000; Qian 1996; Xu 2001; Zhou 1998). Details of excluded studies are given in the table of excluded studies.
*In this group, six authors (Cha 1998; Chen 2004; He 2000; Li 1995; Wang 1999; Ye 2006) were interviewed by telephone and were also excluded because the authors misunderstood the concept of randomisation.
Included studies
Only six studies (Chen 1984a; Chen 1984b; Chen 2001; Li 2004; Wang 1994; Zhang 1996) were included in the review (Figure 1).
 | Figure 1. |
Chen 1984a was considered to be a quasi-RCT due to the fact that allocation was performed by odd or even number of admission order. Nonetheless it was our decision to include this trial as it represents the first clinical trial of danshen compounds for AMI supported by the Beijing government, and was carried out in several leading institutions. We included Chen 1984a rather than CYG 1981 because we noted that they were conducted concurrently in the same hospital and have the same project name, the sole differences being the authors' name and sample size, with CYG 1981 reporting 276 cases and Chen 1984a reporting 430 cases. From these findings we surmised that CYG 1981 was included in Chen 1984a.
Chen 2001 was included as an RCT although there are still some uncertanties, for example, the authors were unable to remember the randomisation method, the paper was published 3 years after the study closed, and there were no usable data except the number of death. The reason for including this paper is pricipally to focus on discussing the shortcomings of trials of traditional Chinese medicine.
Only Chen 1984b was considered an RCT (dependent on the description provided in the paper as "strictly random allocation") and as such was one of the most important studies of Danshen for AMI. We did not include other claimed RCTs or quasi-RCTs for the reason of poor methodology.
Although Wang 1994 was not an RCT but rather a retrospective study, it was included because the randomisation to fufang danshen injection for treating AMI was felt to provide potentially important information, and the study was conducted in leading institutions under the support of the Shanghai government and with Huashan Hospital of Shanghai First University of Medical Sciences as a leader of this multicentre study. Patients were also treated in a standardised fashion and were monitored carefully, suggesting that the study might provide particularly worthwhile information.
Li 2004 and Zhang 1996 were included becuase they appeared (from the information provided) to be RCTs; unfortunately we were not able to contact the authors by telephone to clarify this issue.
All of the studies were published in Chinese.
A total of 2368 participants are included in the review. Numbers of participants in the individual studies ranged from 68 (Zhang 1996) to 1350 (Wang 1994).
All of patients had been diagnosed with AMI by using the WHO 1979 diagnosis criteria. Only one study (Chen 1984a) mentioned the traditional Chinese medicine (TCM) sign 'zheng' - 232 patients were recognised as 'qixu xueyu zheng' and some were 'yingxu xueyu' and 'xueyu'. However no numerical information was provided.
Interventions of included studies
Two studies (Chen 1984a and Chen 1984b) used the same interventions, where danshen was the principle ingredient of a 'kangxingeng heji' decoction and 'yiqi huoxue' injection. Within the first 6 hours of enrolment, AMI patients were treated with a 10 mL 'yiqi huoxue' injection together with a 250 mL infusion of 5% glucose infusion given by intravenous drip, which 1 week later was changed to taking 'kangxingeng heji' orally.
Both the 'quyu huatan xiezhu' and 'yiqi huoxue' formulations in the study by Chen 2001 contain the basic elements danshen, chishao and honghua.
Li 2004 compared huangqi injection with danshen injection versus placebo, and shenmai injection with danshen injection versus placebo, respectively.
Wang 1994 used intravenous danshen injection.
Zhang 1996 used isosorbide dinitrate in the experimental group, and isosorbide dinitrate plus danshen injection in the control group.
See the Characteristics of included studies table for additional details.
Outcome measures of included studies
All studies reported mortality. Chen 2001 listed frequency of angina pectoris, change of lung moist rales, and change of arrhythmia as outcomes, but there were no data that could be used for analysis. Zhang 1996 reported on improvement of heart function, but the data was unusable.
Risk of bias in included studies
All of the six included trials were of low quality (see Characteristics of included studies table).
Randomisation
Although all of the studies mentioned random allocation of participants, overall reporting of methods was poor. In Chen 1984a it is mentioned that the patients with odd numbers were allocated to use 'yiqi huoxue' injection and to take 'kangxingeng heji' decoction, and the study was therefore considered as quasi-randomised. The authors of Chen 2001 could not recall what method of randomisation was used. In Chen 1984b it is stated that investigators "collected the strictly randomly allocated patients' data for analysis", and the study was therefore considered to be a valid RCT. The description in Wang 1994 states that "patients were randomly allocated to danshen or control depending on whether they used danshen or not", and was considered to be a retrospective study. For Li 2004 and Zhang 1996 attempts to contact the authors were unsuccessful. None of the studies concealed allocation.
Blinding
None of the studies used blinding.
Description of withdrawals and losses to follow up and intention-to-treat analysis
None of the included studies mentioned drop-outs or performed an intention-to-treat analysis.
Compliance assessment
None of the studies mentioned any methods of ensuring or assessing compliance.
Similarity of comparison groups at baseline
Comparisons of groups at baseline was mentioned in all of the included studies, and included age, sex, degree of heart dysfunction, infarct lacations, and disease duration, at time of entry into the study. However in some studies baselines were dissimilar, for example in Chen 1984a there were 10 patients with the cardiogenic shock in the danshen group and 16 in the control group. In addition, 87 patients in the danshen group and 63 in the control group had heart failure.
Effects of interventions
Mortality
The results for mortality are shown in comparison 01. The quasi-randomised study reported in Chen 1984a demonstrated a significant difference favouring treatment with danshen versus controls (Peto OR 0.42, 95% CI 0.23 to 0.77). The study reported in Chen 1984b, the sole investigation in this review that could confidently be considered an RCT, again showed fewer deaths in the group treated with danshen than the control group (8/112 versus 14/112, respectively), but in this case the difference was not statistically significant (Peto OR 0.55, 95% CI 0.23 to 1.32). However pooled analysis of these two studies using a fixed-effect model did yield a significant difference favouring danshen preparations (Peto OR 0.46, 95% CI 0.28 to 0.75). Although the number of studies is small and the rigour of conducting the trials somewhat uncertain, the results suggest that danshen therapy may reduce the death rate in AMI compared with conventional western therapy alone.
Chen 2001 concluded that the 'quyu huatan xiezhuo' formulation reduced both frequency of angina pectoris and onset of arrhythmia as compared with the 'yiqi huoxue' formulation (P < 0.01, 0.05, respectively), but otherwise the author did not provide any useful data. There was no statistically significant difference between the two groups in mortality, with six deaths in a group of 61 patients in the 'quyu huatan xiezhuo' group, and four deaths among 60 patients in the 'yiqi huoxue' group (Peto OR 1.51, 95% CI 0.42 to 5.49).
The study described in Li 2004 reported a single death in both the shenmai injection plus danshen injection group and the huangqi injection plus danshen groups, with eight deaths in each control group. There was a borderline statistically significant difference in the former (Peto OR 0.25, 95% CI 0.06 to 0.97), but not the latter (Peto OR 0.32, 95% CI 0.08 to 1.34).
In the retrospective study reported in Wang 1994, an analysis of total mortality did not show a significant advantage for danshen (Peto OR 0.78, 95% CI 0.59 to 1.03; data not shown), whereas analysis according to gender showed an advantage for Danshen in males but not females (Peto OR 0.70, 95% CI 0.50 to 0.97 for men; 0.78, 95% CI 0.59 to 1.03 for women). However these values lie very close to one another and are of doubtful clinical significance.
The study reported in Zhang 1996 cites the number of deaths in the study groups in the results section, although mortality was not listed as an outcome. Deaths in the isosorbide dinitrate plus danshen group numbered six of 24 patients, and in the isosorbide dinitrate group two of 24 patients, a non-significant difference (Peto OR 3.05, 95% CI 0.71 to 13.21).
In summary, this group of studies, which are often questionable in both design and interpretation, also collectively do not offer strong support for the use of danshen in treating AMI.
Rate of severe arrhythmia
The study reported in Li 2004 indicated that the use of both fufang danshen injection plus huangqi injection and fufang danshen injection plus shenmai injection significantly reduced the rate of severe arrhythmia (Peto OR 0.28, 95% CI 0.12 to 0.67, and Peto OR 0.42, 95% CI 0.20 to 0.91, respectively).
Rate of heart failure
The study reported in Li 2004 indicated that the use of fufang danshen injection plus huangqi injection failed to reduce the rate of heart failure (Peto OR 0.49, 95% CI 0.13 to 1.89), whereas use of fufang danshen injection with shenmai injection did show a significant advantage (Peto OR 0.16, 95% CI 0.04 to 0.65).
Discussion
We found that studies of danshen preparations for AMI were inadequate to provide reliable estimates on the effects, due to poor study design and methodological quality of the research protocols. The following need to be considered:
1. All of the studies located were Chinese language publications, facilitating our telephone contact with many of the trial authors about the method of randomisation they used. Although a large number of the trials claimed to be RCTs, we found that few of the authors had described the concept of randomisation correctly. In addition to this, some of the studies were conducted several years prior to publication, and the trial authors in some instances seemed unfamiliar with the details of the methodology they employed. Even in some leading institutions such as those connected with the studies reported in Chen 1984a and Wang 1994, the description of the randomisation process sometimes appeared flawed. None of the trials used concealment of allocation. These two limitations may have resulted in a high risk of selection bias.
2. None of studies mentioned ethical issues or whether the participants gave informed consent.
3. We found that in all of the trials using danshen, the comparator treatment or 'basal or routine treatment' was often sub-optimal with some patients receiving only nitrates, and not low molecular weight heparin or other effective remedies (ICSI 2005). Consequently, danshen may have shown exaggerated beneficial effects in such trials.
4. A large number of the trials used self-prepared formulation or hospital-made preparations for treating AMI. Although Chinese herbal medicine as a treatment for diseases and their method of manufacture are widely accepted in China, many of the constituents of the pharmacologically prepared drugs used in trials cannot be clearly specified. This is in marked contrast to pharmacological agents used in western medicine, in which the chemical constituents, their quantities, the percentage of any impurities or contaminants are precisely known and the variation between different production batches is kept within specified limits. Variation between formulations and batches of treatments are inevitable consequences of traditional Chinese medicine, though the Chinese government does specify the acceptable limits of variation. However this variation is a factor that may contribute to any heterogeneity between different study results.
One must accept the fact that the overall treatment concept for traditional Chinese medicine is different from that used in Western medicine. Nonetheless, when a study uses a self-prepared herbal formulation, the quality of herbs and methods of preparation should be stated in detail, in order to achieve consistent effects.
5. It is noteworthy that in Chen 2001 an attempt was made to explore the effects of different Danshen compounds for AMI patients with different types of the traditional Chinese medicine sign 'zheng'. Sixty-one AMI patients were in the 'quyu huatan xiezhuo' group, of these nine were 'qixu xueyu zheng', three with both 'qi and yin xu zheng', four with 'tanshi zhuci zheng'and 45 with 'tanyu huzhu zheng' (means both 'tan and yu' stasis and interacted each other). Of 60 in the 'yiqi huoxue' group, six were with "qixu xueyu zheng', three with both 'qi and yin xu zheng', three with 'tanshi zhucu zheng' and 48 with 'tanyu huzhu zheng'. The results appeared to suggest that 'quyu huatan xiezhuo' formulation is superior to 'yiqi huoxue' formulation in improving heart function and heart failure, and reducing angina attack and arrhythmia. This result alludes to that (1) traditional Chinese medicine preparations should be used according to the traditional Chinese medicine signs 'zheng' of patients strictly; and (2) most AMI patients are with 'tanyu huzhu zheng'. Regrettably the authors did not perform a stratification analysis by 'zheng'. There is a need to conduct more and better designed studies to test whether use of danshen preparations for treating AMI is dependent on the traditional Chinese medicine 'zheng' or not.
6. We also noted that if danshen was studied as the experimental drug, it tended to show a better result than the controls, and that conversely when danshen was an agent in the control group, the experimental drug tended to be superior to danshen. For example in Chen 1984a and Chen 1984b as well as in other excluded studies such as Han 1992 and Liang 2001 in which danshen preparations was used as the experimental intervention, positive effects of danshen were noted. In contrast, in Zhang 1996, in which isosorbide dinitrate was used as the experimental drug and the control group was given isosorbide dinitrate plus danshen injection, there was a trend for the former treatment to be superior to the latter treatment, albeit not significantly so. However these somewhat inconsistent results may result at least in part from selection bias or detection bias, and possibly even conflict of interest should be considered.
7. We did not find any studies that reported calculation of sample size requirements. This may explain the conduct of smaller studies with low power to detect clinically important differences. Any future studies should be adequately powered.
Authors' conclusions
Implications for practice From the six studies included in this review, it is concluded that, although danshen compound may possibly have beneficial effects on AMI mortality compared to routine treatments, the evidence must be considered inconclusive. This is because of the small number of available studies which were of poor quality. In addition, the safety of danshen preparation is unproven because of the lack of toxicological evidence, although adverse events have only rarely been reported. |
Implications for research Further research should consider the following points: The reporting of the trials should focus in detail on how to achieve allocation concealment and blinding of participants, investigators and outcome assessors, according to CONSORT for traditional Chinese medicine (Wu 2007) and CONSORT (Moher 2001). In particular the statement should include: |
Acknowledgements
This publication was made possible in part by Grant Number 1 R24 AT001293-01 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this review are solely the responsibility of the authors and do not necessarily represent the official views of the NCCAM, or the National Institutes of Health.
We thank the Cochrane Heart Group editorial board for their kind help for writing this review.
We thank Zhou Likun, Duan Xin, Qiao Jieqi, Chen Xiaoyan, Zhen Jie, Wang Qin for their contribution to the handsearch.
Data and analyses
- Top of page
- Background
- Objectives
- Methods
- Results
- Discussion
- Authors' conclusions
- Acknowledgements
- Data and analyses
- What's new
- History
- Contributions of authors
- Declarations of interest
- Sources of support
- Index terms
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What's new
Last assessed as up-to-date: 13 February 2008.
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History
Protocol first published: Issue 3, 2003
Review first published: Issue 2, 2008
Contributions of authors
Taixiang, Wu
Protocol development, searching for trials, quality assessment of trials, data extraction, data analysis, telephone interview the original authors, review development.
Juan, Ni
Protocol development, searching for trials, quality assessment of trials, data extraction, telephone interview the original author..
Jiafu, Wei
Searching for trials, quality assessment of trials, data extraction.
Declarations of interest
None known.
Sources of support
Internal sources
- Chinese Cochrane Centre, West China Hospital of Sichuan University, China.
External sources
- National Center for Complementary and Alternative Medicine (NCCAM), USA.
Index terms
Medical Subject Headings (MeSH)
*Phytotherapy [adverse effects]; *Salvia miltiorrhiza; Drugs, Chinese Herbal [adverse effects; *therapeutic use]; Myocardial Infarction [*drug therapy; mortality]; Phenanthrolines [adverse effects; *therapeutic use]; Randomized Controlled Trials as Topic
MeSH check words
Humans
* Indicates the major publication for the study