Traditional Chinese Medicine Compound and Clinical Outcomes in Acute Myocardial Infarction

Abstract

To the Editor The China Tongxinluo Study for Myocardial Protection in Patients With Acute Myocardial Infarction (CTS-AMI) 1 recently showed that the Chinese traditional medicine Tongxinluo significantly improved both 30-day and 1-year clinical outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI). However, we are concerned that patient risk stratification was not included in this study.The 2020 ESC guidelines for the management of acute coronary syndromes and the 2021 AHA/ACC/ASE/CHEST/ SAEM/SCCT/SCMR guidelines for the evaluation and diagnosis of chest pain recommended use of risk stratification to identify best treatment modality and estimate patients' prognostic outcome. A variety of prognostic models have been elucidated with the aim of assessing the risk of all-cause mortality or the combined risk of all-cause mortality or myocardial infarction. 2,3 The Thrombolysis in Myocardial Infarction (TIMI) algorithm was first introduced to calculate risk stratification in patients with acute coronary syndrome. 4 The second most commonly used score is the Global Registry of Acute Coronary Events (GRACE) risk model, which incorporated a more representative community-based registry. The GRACE risk score has been found to be more effective at predicting risk of mortality or myocardial infarction when compared with subjective physician evaluation. 2 Although the CTS-AMI 1 study reported prognostic risk factors of mortality in STEMI, such as age, sex, diabetes, hypertension, and medications (aspirin, angiotensin-converting enzyme inhibitors, statins, and β-blockers), its omission of risk stratification may have affected the study results because these tools are necessary to choose the best STEMI treatment modalities based on the guidelines. 2,3