Effects of Shen-Yuan-Dan on Periprocedural Myocardial Injury and the Number of Peripheral Blood Endothelial Progenitor Cells in Patients with Unstable Angina Pectoris Undergoing Elective Percutaneous Coronary Intervention

Overview

Journal Evid Based Complement Alternat Med

Specialty Rehabilitation Medicine

Date 2022 Jan 17

PMID 35035512

Authors

Zhenmin Zhang

Wenlong Xing

Hongxu Liu

Qi Zhou

Xinyi Liu

JuJu Shang

Affiliations

Soon will be listed here.

Abstract

Objectives: We aimed to investigate the effects of Shen-Yuan-Dan (SYD), a Chinese medicine preparation, on periprocedural myocardial injury (PMI) and the number of peripheral blood endothelial progenitor cells (EPCs) in patients with unstable angina pectoris (UA) who underwent elective percutaneous coronary intervention (PCI).

Methods: Patients were randomly divided into the experimental (group A) and control (group B) groups through the random number table method. In group A, patients concurrently received the conventional western treatment and SYD orally (4 capsules/time, 3 times/d, from 3 d before surgery to 7 d after surgery). In group B, patients received conventional Western medicine treatment. Both groups underwent coronary angiography, and patients undergoing PCI were eventually included in the study. The following patient data were collected: incidence of PMI, serum CK-MB content before PCI, 4 h, 24 h, and 7 d after PCI, number of CD45dim/-CD34+CD309+ peripheral venous EPCs, and number of CD184 coexpressed EPCs. The incidence of adverse reactions and 30-day major adverse cardiovascular events (MACEs) were also recorded.

Results: Sixty-two patients were finally included in this study, with 32 and 30 in groups A and B, respectively. In group A, the number of peripheral blood EPCs and the number of CD184 coexpressed EPCs at 1 h before surgery were higher than those at 3 d before surgery (37.24 ± 25.20 vs. 22.78 ± 9.60/ml; < 0.001 and 23.38 ± 15.30 vs. 13.54 ± 8.08/ml; < 0.001, resp.). The number of peripheral blood EPCs and number of CD184 coexpressed EPCs at 4 h after surgery were lower than those at 1 h before surgery (25.30 ± 11.90 vs. 37.24 ± 25.20/ml; =0.019 and 15.38 ± 8.78 vs. 23.38 ± 15.30/ml; =0.013, resp.), but there was no difference at 24 h and at 7 d after surgery in comparison with that at 1 h before surgery ( > 0.05). In group B, compared with that at 1 h before surgery, there existed a decline in the number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs at 4 h after surgery, but without a statistical difference ( > 0.05). Comparing both groups, it was found that the incidence of PMI in group A was lower (6.25% vs. 26.67%; =0.04), and the serum CK-MB content at 4 and 24 h after surgery was also lower than that in group B (17.33 ± 5.83 vs. 20.38 ± 4.32 U/l; =0.048 and 15.79 ± 5.32 vs. 19.10 ± 4.93 U/l; =0.030, resp.). The number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs in group A were higher than those in group B at 1 h before surgery (37.24 ± 25.20 vs. 22.36 ± 12.26/ml; =0.034 and 23.38 ± 15.30 vs. 13.12 ± 14.62/ml; =0.013, resp.). In addition, there were no obvious adverse reactions and no 30-day MACEs in both groups during the trial.

Conclusion: SYD can reduce PMI and promote the mobilization of EPCs in the perioperative period of elective PCI in patients with UA.

Citing Articles

Protective effects of Shen Yuan Dan on myocardial ischemia-reperfusion injury via the regulation of mitochondrial quality control.

Zhang Z, Zhou M, Liu H, Liu W, Chen J Cardiovasc Diagn Ther. 2023; 13(2):395-407.

PMID: 37583687 PMC: 10423729. DOI: 10.21037/cdt-23-86.

Yangxin decoction for the treatment of angina pectoris of coronary heart disease: A systematic review of randomized controlled trial.

Yu X, Yu X, Xu Z, Li H Medicine (Baltimore). 2022; 101(35):e30394.

PMID: 36107541 PMC: 9439739. DOI: 10.1097/MD.0000000000030394.

References

Hu C, Ke X, Chen K, Yang D, Du Z, Wu G . Transplantation of human umbilical cord-derived endothelial progenitor cells promotes re-endothelialization of the injured carotid artery after balloon injury in New Zealand white rabbits. Chin Med J (Engl). 2013; 126(8):1480-5. View

Gravanis M, Roubin G . Histopathologic phenomena at the site of percutaneous transluminal coronary angioplasty: the problem of restenosis. Hum Pathol. 1989; 20(5):477-85. DOI: 10.1016/0046-8177(89)90014-2. View

Ricottini E, Madonna R, Grieco D, Zoccoli A, Stampachiacchiere B, Patti G . Effect of High-Dose Atorvastatin Reload on the Release of Endothelial Progenitor Cells in Patients on Long-Term Statin Treatment Who Underwent Percutaneous Coronary Intervention (from the ARMYDA-EPC Study). Am J Cardiol. 2016; 117(2):165-71. DOI: 10.1016/j.amjcard.2015.10.043. View

Schmidt-Lucke C, Rossig L, Fichtlscherer S, Vasa M, Britten M, Kamper U . Reduced number of circulating endothelial progenitor cells predicts future cardiovascular events: proof of concept for the clinical importance of endogenous vascular repair. Circulation. 2005; 111(22):2981-7. DOI: 10.1161/CIRCULATIONAHA.104.504340. View

Thomas H, Avery P, Ahmed J, Edwards R, Purcell I, Zaman A . Local vessel injury following percutaneous coronary intervention does not promote early mobilisation of endothelial progenitor cells in the absence of myocardial necrosis. Heart. 2008; 95(7):555-8. DOI: 10.1136/hrt.2008.146662. View

Jang Y, Zhu J, Ge J, Kim Y, Ji C, Lam W . Preloading with atorvastatin before percutaneous coronary intervention in statin-naïve Asian patients with non-ST elevation acute coronary syndromes: A randomized study. J Cardiol. 2013; 63(5):335-43. DOI: 10.1016/j.jjcc.2013.09.012. View

Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G . Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study. Circulation. 2004; 110(6):674-8. DOI: 10.1161/01.CIR.0000137828.06205.87. View

Crosby J, Kaminski W, Schatteman G, Martin P, Raines E, Seifert R . Endothelial cells of hematopoietic origin make a significant contribution to adult blood vessel formation. Circ Res. 2000; 87(9):728-30. DOI: 10.1161/01.res.87.9.728. View

Thygesen K, Alpert J, Jaffe A, Chaitman B, Bax J, Morrow D . Fourth Universal Definition of Myocardial Infarction (2018). Glob Heart. 2018; 13(4):305-338. DOI: 10.1016/j.gheart.2018.08.004. View

10.

Seeger F, Rasper T, Koyanagi M, Fox H, Zeiher A, Dimmeler S . CXCR4 expression determines functional activity of bone marrow-derived mononuclear cells for therapeutic neovascularization in acute ischemia. Arterioscler Thromb Vasc Biol. 2009; 29(11):1802-9. DOI: 10.1161/ATVBAHA.109.194688. View

11.

Hristov M, Zernecke A, Liehn E, Weber C . Regulation of endothelial progenitor cell homing after arterial injury. Thromb Haemost. 2007; 98(2):274-7. View

12.

Austin G, Ratliff N, Hollman J, Tabei S, Phillips D . Intimal proliferation of smooth muscle cells as an explanation for recurrent coronary artery stenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1985; 6(2):369-75. DOI: 10.1016/s0735-1097(85)80174-1. View

13.

Hristov M, Erl W, Weber P . Endothelial progenitor cells: mobilization, differentiation, and homing. Arterioscler Thromb Vasc Biol. 2003; 23(7):1185-9. DOI: 10.1161/01.ATV.0000073832.49290.B5. View

14.

Aicher A, Heeschen C, Mildner-Rihm C, Urbich C, Ihling C, Technau-Ihling K . Essential role of endothelial nitric oxide synthase for mobilization of stem and progenitor cells. Nat Med. 2003; 9(11):1370-6. DOI: 10.1038/nm948. View

15.

Vane J, Anggard E, Botting R . Regulatory functions of the vascular endothelium. N Engl J Med. 1990; 323(1):27-36. DOI: 10.1056/NEJM199007053230106. View

16.

Montenegro F, Correia M, Muccillo F, Souza E Silva C, De Lorenzo A . Associations between endothelial progenitor cells, clinical characteristics and coronary restenosis in patients undergoing percutaneous coronary artery intervention. BMC Res Notes. 2018; 11(1):278. PMC: 5941758. DOI: 10.1186/s13104-018-3401-y. View

17.

Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T . Isolation of putative progenitor endothelial cells for angiogenesis. Science. 1997; 275(5302):964-7. DOI: 10.1126/science.275.5302.964. View

18.

Gao M, Yao Q, Liu Y, Sun F, Ma Y, Sun G . Association between mobilization of circulating endothelial progenitor cells and time or degree of injury from angioplasty in patients with exertional angina: A prospective study. Exp Ther Med. 2015; 10(2):809-815. PMC: 4509458. DOI: 10.3892/etm.2015.2571. View

19.

Bulluck H, Paradies V, Barbato E, Baumbach A, Botker H, Capodanno D . Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous.... Eur Heart J. 2021; 42(27):2630-2642. PMC: 8282317. DOI: 10.1093/eurheartj/ehab271. View

20.

Bonello L, Basire A, Sabatier F, Paganelli F, Dignat-George F . Endothelial injury induced by coronary angioplasty triggers mobilization of endothelial progenitor cells in patients with stable coronary artery disease. J Thromb Haemost. 2006; 4(5):979-81. DOI: 10.1111/j.1538-7836.2006.01858.x. View