Association between yangxinshi and 1-year all-cause mortality in patients with coronary artery disease without prior cardiovascular events

Background The role of traditional Chinese medicine in improving prognosis among patients with coronary artery disease (CAD) without prior cardiovascular events remains unclear. We investigated the association between Yangxinshi (YXS) tablet use and 1-year all-cause mortality in this population. Methods In this multicenter, real-world cohort study, we consecutively enrolled 32,397 patients with coronary artery disease (CAD), identified using ICD-10 codes, from 82 hospitals between 2010 and 2024. All patients had no prior history of myocardial infarction, stroke, or heart failure at baseline. Propensity score matching (1:2) generated 5,607 YXS users and 11,155 non-users with well-balanced baseline characteristics, including demographics, comorbidities, NYHA class, and guideline-directed medical therapy. The primary endpoint was 1-year all-cause mortality. Kaplan–Meier analysis and multivariable Cox proportional hazards models were performed. Prespecified subgroup analyses were conducted to evaluate potential effect modification. Results After PSM, covariates were comparable between groups (all p>0.05) (Figure 1). During 1-year follow-up, YXS use was associated with significantly lower all-cause mortality (log-rank p<0.001) (Figure 2A). In adjusted Cox analysis, YXS was independently associated with reduced mortality (aHR=0.66, 95% CI: 0.54–0.79, p<0.001). The mortality reduction was consistent across subgroups defined by age, diabetes, hypertension, atrial fibrillation, stroke history, and renal insufficiency (all p for interaction >0.05) (Figure 2B). Conclusions Among patients with CAD without prior cardiovascular events, YXS use was associated with a significant reduction in 1-year all-cause mortality independent of standard medical therapy. These findings suggest a potential adjunctive role of YXS in early-stage CAD management and merit confirmation in randomized trials.Baseline Characteristics TableKM curves and Subgroups Analyses