Efficacy and safety of combining commercial Chinese polyherbal preparation with conventional medicine in the treatment of coronary microvascular disease: a systematic review and network meta-analysis

Objective: To systematically assess and compare the efficacy and safety of 19 commercial Chinese polyherbal preparation for coronary microvascular disease (CMVD) through a frequentist network meta-analysis (NMA) of randomized controlled trials. Methods: A comprehensive search was performed across multiple databases through November 2025 to identify studies evaluating the effectiveness of CCPPs in treating CMVD. Two independent reviewers screened studies, extracted data, and assessed risk of bias. The NMA was conducted using a frequentist random-effects model, and statistical analyses were performed in Stata 18.0. Network diagrams, league tables, and SUCRA (surface under the cumulative ranking curve) plots were generated to compare and rank the treatments. Results: Sixty-seven randomized controlled trials (RCTs) involving 6,139 patients were included. All CCPPs combined with conventional medicine (CM) demonstrated potential advantages in efficacy compared to CM alone, but the optimal agent is highly outcome-specific. Yixinshu Tablets may be more favorable for improving microvascular function by reducing the index of microcirculatory resistance (IMR) and increasing coronary flow reserve (CFR). Tongxinluo Capsule showed a relatively greater reduction in corrected thrombolysis in myocardial infarction frame count (cTFC) and a higher total effective rate in the included studies. Shexiang Tongxin Dripping Pills was associated with a more pronounced elevation in left ventricular ejection fraction (LVEF). Danshen Dripping Pills ranked highest for reducing endothelin-1 (ET-1) and increasing nitric oxide (NO) levels. Yindan Xinnao Tong Capsules exhibited a relatively greater decrease in high-sensitivity C-reactive protein (hs-CRP). Additionally, Shexiang Baoxin Pills was associated with the lowest risk of adverse events. Conclusion: The combination of CCPPs with CM for CMVD may be associated with improved clinical outcomes compared to CM alone. However, these initial results require confirmation through high-quality, rigorously designed clinical trials. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251245224, identifier CRD420251245224.