AIM  To observe the combined effect of enhanced external counterpulsation (EECP) and Buyanghuanwu Decoction on angina pectoris after coronary stent implantation (PCI).

  METHODS  Two hundred and ten patients with angina pectoris after PCI in the Department of Cardiology, First Affiliated Hospital of Air Force Medical University from March 2014 to October 2018 were selected. The patients were randomly divided into routine treatment group (routine group), Buyanghuanwu Decoction treatment group (trial group), and EECP and Buyanghuanwu Decoction combined treatment group (combination group), with 70 cases in each group. Follow-up was conducted after 1, 3 and 6 months of treatment and the patients’ basic medication was adjusted according to their conditions. The frequency of angina attack was recorded before treatment and 1, 3 and 6 months after treatment. During the first, third and sixth months of treatment, the patients underwent exercise plate electrocardiogram examination. The levels of nitric oxide (NO), endothelin-1 (ET-1) and hypersensitive C-reactive protein (hs-CRP) were measured by immunohistochemistry before the trial and 1 month after the treatment. Before and after 6 months of treatment, levels of vascular endothelial growth factor (VEGF) were measured by immunohistochemistry and myocardial ischemia was measured by resting myocardial nuclide imaging.

  RESULTS  After 1 month of treatment, compared with that in the routine group, the frequency of angina attack in the combination group and the trial group was reduced and the difference was statistically significant (P< 0.01). After 3 months, compared with that in the routine group, the frequency of angina attack in the combination group and the trial group further decreased (P< 0.01). After 6 months of treatment, compared with that in the routine group, the frequency of angina attack in the combination group and the trial group was significantly lower and the difference was statistically significant (P< 0.01). One month after treatment, exercise plate electrocardiogram positive rate differences between groups had no statistical significance. Three months after treatment, the rate of exercise plate electrocardiogram in the combination group was lower than that in the normal group and the difference was statistically significant (P< 0.05). Six months after treatment, the positive rate of exercise plate electrocardiogram (ECG) in both the trial group and the combined group was significantly improved and the differences were statistically significant (P< 0.01) and the improvement in the combination group was better than that in the trial group (P< 0.05). After 1 month of treatment, NO levels in all three groups increased, with the most significant increase in the combined group and the differences were statistically significant (P< 0.01). Compared with those in the routine group, the levels of ET-1 and hs-CRP in the combined group decreased more significantly. After 6 months of treatment, compared with that in the routine group and the trial group, VEGF level in the combined treatment group was significantly increased, with statistically significant differences (P< 0.05). After 6 months of treatment, resting myocardial radionuclide imaging indicated that compared with the routine group, the combined group had the most significant decrease in myocardial ischemic area, with statistically significant difference (P< 0.01).

  CONCLUSION  In patients with angina pectoris after PCI, the treatment of Buyanghuanwu Decoction combined with EECP can significantly reduce the angina attack and improve the results of flat ECG, which may be related to the improvement of collateral circulation and the reduction of ischemic myocardial area and then the improvement of the myocardial tolerance by optimizing the vasoactive substances.