Long-term efficacy of the <i>Astragalus-Salvia miltiorrhiza</i> botanical drug pair in stable coronary artery disease and a nomogram for predicting frequent hospitalization: a real-world retrospective cohort study.

Abstract

To evaluate the long-term efficacy and safety of the <i>Astragalus-Salvia miltiorrhiza</i> (ASM) botanical drug pair as an adjunctive therapy for stable coronary artery disease (SCAD) and to develop a prognostic nomogram for frequent readmissions. This real-world retrospective cohort study included 686 SCAD patients (343 receiving ASM plus standard care and 343 receiving standard care alone). Inverse probability of treatment weighting (IPTW) was applied to balance covariates. After a 5-year follow-up, biochemical parameters, primarily low-density lipoprotein cholesterol (LDL-C), and safety profiles were compared. Furthermore, multivariable logistic regression was used to construct a nomogram predicting frequent readmissions (&#x2265;3 times), and symptom networks were analyzed via the Apriori algorithm to evaluate symptom alleviation. At the 5-year follow-up, compared to controls, the ASM group exhibited significantly reduced LDL-C, total cholesterol (TC), triglycerides (TG), heart rate, and monocytes, alongside elevated high-density lipoprotein cholesterol (HDL-C), free triiodothyronine (FT3), and free thyroxine (FT4) (all <i>P</i> &lt; 0.05). Hepatic and renal functions remained unaffected (<i>P</i> &gt; 0.05). Notably, stroke history emerged as the primary independent risk factor (<i>P</i> &lt; 0.001) for frequent readmissions. The nomogram integrating stroke history, age, diastolic blood pressure, FT3, and hemoglobin demonstrated excellent calibration. Symptom network analysis identified "chest tightness" as the core symptom alleviated by ASM. ASM adjunctive therapy safely improves lipid profiles, stabilizes heart rate, and alleviates chest tightness in SCAD. The proposed nomogram offers a reliable tool for risk stratification, providing real-world evidence to optimize the integrative management of SCAD. https://itmctr.ccebtcm.org.cn/mgt/dashboard, identifier TMCTR2025000058.