Tanhuo Decoction for Acute Coronary Syndrome With Cerebral Atherosclerosis in Elderly Patients

This study adopts a prospective randomized controlled design. Patients with acute coronary syndrome combined with cerebral atherosclerosis who meet the inclusion and exclusion criteria will be randomly assigned in a 1:1 ratio to either the Tanhuo Decoction group or the control group. The Tanhuo Decoction group will receive standard Western medical therapy plus Tanhuo Decoction, while the control group will receive standard Western medical therapy alone. A total of 480 patients are planned to be enrolled. The study will compare changes in white blood cell count and neutrophil count, as well as differences in high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels after 7 days of treatment and at 1 month after discharge. Differences in the Phlegm-Heat Syndrome Score and multi-omics detection results after 7 days of treatment will also be analyzed between the two groups. Changes in left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) at 1 month and 1 year after discharge will be evaluated. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) within 12 months after discharge will be compared between the two groups. MACCE is defined as the occurrence of any of the following events during the follow-up period: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularization. This study aims to evaluate the effectiveness of Tanhuo Decoction in controlling inflammation-related indicators in elderly patients with acute coronary syndrome combined with cerebral atherosclerosis. Outcome measures and clinical endpoints include Phlegm-Heat Syndrome Score, inflammatory markers, cardiac function, and major adverse cardiovascular and cerebrovascular events

Inclusion criteria

• Hemodynamic stability within 24 hours following treatment for acute coronary syndrome
• A confirmed prior diagnosis of ischemic cerebrovascular disease, or the presence of intracranial or extracranial arterial stenosis ≥50%, as verified by carotid and cerebrovascular ultrasound after admission
• Manifestations consistent with fire-heat syndrome, including tongue body appearance, tongue coating, stool characteristics, mental state, facial complexion, breathing pattern, presence of fever, pulse features, oral sensation, and urine properties. A total score of ≥7 points based on the weighted scoring system for each item indicates the presence of fire-heat syndrome.
• Age ≥ 60 years old

Exclusion criteria

• Patients with persistent hemodynamic instability beyond 24 hours, or those with ACS-related hypotension (SBP < 90 mmHg or DBP < 60 mmHg), or requiring coronary artery bypass grafting based on coronary artery lesions
• History of chronic heart failure due to any cause
• History of ischemic stroke, peptic ulcer, active bleeding, or major surgery within the past 3 months
• Hepatic or renal dysfunction, defined as ALT or AST levels >5 times the upper limit of normal, or estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m²
• Previous history of bronchial asthma
• Platelet count <80×10⁹/L or anemia (hemoglobin ≤100 g/L)
• Contraindication or allergy to aspirin, clopidogrel, ticagrelor, or statins
• History of malignant tumor
• Known allergy to components of traditional Chinese medicine