Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis
- 1Graduate School, Beijing University of Chinese Medicine
- 2Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
Abstract
Background: Traditional Chinese medicine injections (TCMIs) are widely employed by Chinese clinicians as adjuvant therapy for Ischemic Heart Failure(IHF). A Bayesian network meta-analysis was conducted to compare the efficacy and safety of conventional treatment (CT) to those that included six TCMIs in patients with IHF.
Objective: To compare the efficacy and safety of six TCMIs as adjuncts to CT for IHF using Bayesian network meta-analysis.
Methods: Eight databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, the Cochrane Library, and Web of Science) were searched from inception to May 6, 2026, for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2.0, certainty of evidence using CINeMA, and Bayesian analyses using R 4.6.0 and Stata 17.0.
Results: A total of 154 RCTs involving 13,756 participants were included. Compared with CT alone, adjunctive TCMIs generally improved clinical response and left ventricular ejection fraction(LVEF), and reduced B-type natriuretic peptide(BNP) and left ventricular end-diastolic dimension(LVEDD); effects on N-terminal pro-B-type natriuretic peptide(NT-pro BNP) were uncertain. Surface under the cumulative ranking curve(SUCRA) estimates Shenmai injection(SMI) had the highest probability of ranking favorably for clinical effectiveness rate(CER) and left ventricular ejection fraction(LVEF), Shengmai injection(SHMI) for B-type natriuretic peptide(BNP), Xinmailong injection(XMLI) for N-terminal pro-B-type natriuretic peptide(NT-pro BNP), Yiqifumai injection(YQFMI) for left ventricular end-diastolic dimension(LVEDD), and Shenfu injection(SFI) for 6-minute walking distance(6MWT). Short-term adverse-event rates were not increased overall.
Conclusion: TCMIs combined with CT has potential benefits in the treatment of IHF, but confidence in treatment rankings is limited by low or very low certainty of evidence, substantial heterogeneity for several outcomes, methodological limitations, and the absence of direct head-to-head trials. Large, rigorously designed RCTs with long-term safety follow-up are required.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier (CRD 420261380716).
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BibTeX
@article{shang2026comparative,
title = {{Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis}},
author = {Yu Shang and Penglu Wei and Yue Mao and Jinhao Tian and Xiaolei Lai and Wenlong Xing and Juju Shang and Hongxu Liu},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1969858},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969858/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis
AU - Yu Shang
AU - Penglu Wei
AU - Yue Mao
AU - Jinhao Tian
AU - Xiaolei Lai
AU - Wenlong Xing
AU - Juju Shang
AU - Hongxu Liu
PY - 2026
DA - 2026/10/30
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1969858
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969858/full
AB - Background: Traditional Chinese medicine injections (TCMIs) are widely employed by Chinese clinicians as adjuvant therapy for Ischemic Heart Failure(IHF). A Bayesian network meta-analysis was conducted to compare the efficacy and safety of conventional treatment (CT) to those that included six TCMIs in patients with IHF. Objective: To compare the efficacy and safety of six TCMIs as adjuncts to CT for IHF using Bayesian network meta-analysis. Methods: Eight databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, the Cochrane Library, and Web of Science) were searched from inception to May 6, 2026, for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2.0, certainty of evidence using CINeMA, and Bayesian analyses using R 4.6.0 and Stata 17.0. Results: A total of 154 RCTs involving 13,756 participants were included. Compared with CT alone, adjunctive TCMIs generally improved clinical response and left ventricular ejection fraction(LVEF), and reduced B-type natriuretic peptide(BNP) and left ventricular end-diastolic dimension(LVEDD); effects on N-terminal pro-B-type natriuretic peptide(NT-pro BNP) were uncertain. Surface under the cumulative ranking curve(SUCRA) estimates Shenmai injection(SMI) had the highest probability of ranking favorably for clinical effectiveness rate(CER) and left ventricular ejection fraction(LVEF), Shengmai injection(SHMI) for B-type natriuretic peptide(BNP), Xinmailong injection(XMLI) for N-terminal pro-B-type natriuretic peptide(NT-pro BNP), Yiqifumai injection(YQFMI) for left ventricular end-diastolic dimension(LVEDD), and Shenfu injection(SFI) for 6-minute walking distance(6MWT). Short-term adverse-event rates were not increased overall. Conclusion: TCMIs combined with CT has potential benefits in the treatment of IHF, but confidence in treatment rankings is limited by low or very low certainty of evidence, substantial heterogeneity for several outcomes, methodological limitations, and the absence of direct head-to-head trials. Large, rigorously designed RCTs with long-term safety follow-up are required. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier (CRD 420261380716).
SN - 2297-055X
ER -