Guanxinshutong capsule combined with Western medicine increased clinical effective rate of unstable angina by 19% compared to Western medicine alone (RR 1.19, 95% CI 1.13-1.25).
Systematic Review (n=1,532)
Does guanxinshutong capsule combined with Western medicine improve clinical efficacy and symptoms in patients with unstable angina?
Guanxinshutong capsule as an adjunctive therapy to standard Western medicine significantly improves angina symptoms and clinical efficacy in patients with unstable angina.
Effect estimate: RR 1.19 (95% CI 1.13-1.25)
Absolute Event Rate: 90.8% vs 76.4%
p-value: p=<0.05
Background Unstable angina (UA), characterized by worsening chest pain and increased risk of acute myocardial infarction or sudden death, is a major clinical condition necessitating urgent and effective intervention. Although guanxinshutong capsule (GXST) has demonstrated preliminary therapeutic potential in alleviating angina symptoms, it lacks sufficient and robust clinical evidence to confirm its efficacy and safety in UA treatment. Therefore, further clinical research is urgently needed to validate the practical value of GXST in managing UA. Objective To determine the efficacy and safety of GXST as an adjunctive therapy for UA and to elucidate its potential pharmacological mechanisms. Methods Relevant RCTs were included to investigate the effectiveness of GXST in combination with WM for UA. ROB 2 was applied to assess their methodological quality. The data integration, evidence quality assessment, and trial sequence analysis were performed using R software, the GRADE framework, and TSA software, respectively. Concurrently, the network pharmacology was employed to identify disease-relevant targets, active components, and core targets of GXST. Crucially, bioinformatics analysis was conducted to explore the potential regulatory mechanisms. Results Fifteen RCTs were included. Compared with WM monotherapy, GXST combined with WM exhibited significantly superior efficacy across multiple indicators: clinical effective rate(RR = 1.19, 95% CI = 1.13–1.25), ECG effective rate (RR = 1.20, 95% CI = 1.07–1.34), angina frequency (SMD = −2.20, 95% CI = −3.36 to −1.04), angina duration (SMD = −1.54, 95% CI = −2.14 to −0.94), PV levels(SMD = −0.82, 95% CI = −1.23 to −0.41), FIB levels(SMD = −1.18, 95% CI = −1.50 to −0.86), and TCM syndrome scores (SMD = −1.68, 95% CI = −2.18 to −1.18). However, no significant intergroup differences were detected in CK-MB, cTnI, or ARDI. KEGG enrichment analysis highlighted the PI3K-Akt and MAPK signaling pathways as central to the underlying mechanism. Molecular docking further demonstrated pronounced binding affinities of kaempferol, miltirone, and asiatic acid toward core targets AKT1, MAPK3, and PIK3CA, corroborating their therapeutic potential. Conclusion The combination therapy of GXST and WM significantly boosted clinical efficacy in patients with UA. Its mechanism of action involves regulating the PIK3CA/AKT1 and MAPK3 signaling pathways. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025634213 , PROSPERO CRD42025634213.
Li et al. (Tue,) conducted a systematic review in Unstable angina (n=1,532). guanxinshutong capsule (GXST) combined with Western medicine (WM) vs. Western medicine (WM) alone was evaluated on Clinical effective rate defined by symptom resolution and angina improvement per GCRNCM (RR 1.19, 95% CI 1.13-1.25, p=<0.05). Guanxinshutong capsule combined with Western medicine increased clinical effective rate of unstable angina by 19% compared to Western medicine alone (RR 1.19, 95% CI 1.13-1.25).