To evaluate the association between adjunctive Chinese herbal medicine (CHM) and post-percutaneous coronary intervention (PCI) adverse cardiovascular events in patients with chronic coronary syndrome (CCS), and to identify subgroups that may derive greater benefit from integrative therapy.

This study included 2274 patients with CCS after PCI: 1155 patients in the guideline-directed medical treatment (GDMT) group and 1119 patients in the integrative Chinese and Western medicine (ICWM) group. Exposure was defined as cumulative CHM treatment for > 6 months per year. The primary endpoint was a composite of repeat revascularization and in-stent restenosis (ISR). Kaplan-Meier survival analysis and multivariable Cox regression models were used to assess associations between treatment strategy and study outcomes.

A total of 1054 patients experienced the primary endpoint, including 575 patients (49.80%) in the GDMT group and 479 patients (42.80%) in the ICWM group. Compared with the GDMT group, the ICWM group had lower cumulative incidences of the primary endpoint, repeat revascularization, and ISR (log-rank P < 0.001, P = 0.0018, and P = 0.023, respectively). After full adjustment, ICWM was associated with lower risks of the primary endpoint (adjusted HR = 0.741, 95% CI: 0.654–0.841, P < 0.001), repeat revascularization (adjusted HR = 0.781, 95% CI: 0.686–0.889, P < 0.001), and ISR (adjusted HR = 0.825, 95% CI: 0.686–0.993, P = 0.042). Subgroup analyses suggested a more pronounced association in patients with prior PCI (adjusted HR = 0.59, 95% CI: 0.48–0.73, P < 0.001) and those without multivessel coronary artery disease (adjusted HR = 0.46, 95% CI: 0.32–0.68, P < 0.001).

In this prospective cohort study, adjunctive CHM was associated with lower risks of the composite endpoint of repeat revascularization and ISR, as well as its individual components, in patients with CCS after PCI. The observed association appeared more pronounced in patients with prior PCI and those without multivessel coronary artery disease.

Chinese herbal medicine is widely used as a complement or alternative treatment in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in China. We compared the incidence of the major adverse cardiovascular event (MACE) of CAD patients with or without the complement use of Chinese herbal medicine after PCI.

In this prospective, observational study that was conducted from September 2016 to August 2019 in Fuwai Hospital (China), we followed up consecutive patients who received PCI treatment for two years. MACE was defined as the composite all-cause mortality, revascularization, and myocardial infarction (MI) and was compared between those using (integrative medicine group) or those not using Chinese herbal medicine as an additional treatment to standard Western medicine, with unadjusted (Kaplan-Meier curves) and risk-adjusted (multivariable Cox regression) analyses.

A total of 5942 patients after PCI were enrolled in this study, and 5453 patients were included in the final analysis (4189 [76.8%] male; mean age: 61.9 ± 9.9% years). During the follow-ups, 2932 (53.8%) patients used only Western medicine while 2521(46.2%) patients had used Chinese herbal medicine as an additional treatment to standard Western medicine. Patients in the integrative medicine group (IM group) were older than the Western medicine group (WM group), had more females and less previous MI. The incidence of MACE was 15.3% (449/2932) in WM group and 11.54% (291/2521) in IM group. Cox regression analysis showed that cumulative incidence of MACE was 27% lower in patients of the IM group than those in WM group (hazard ratio = 0.73; 95% CI: 0.63-0.85; P < 0.0001).

For CAD patients after PCI treatment, complement use of Chinese herbal medicine is associated with a lower 2-year MACE incidence. Randomized prospective studies are warranted to provide higher levels of benefit evidence in these patients.