Efficacy and safety of traditional Chinese medicine injections combined with conventional Western medicine for post-AMI heart failure: a systematic review and Bayesian network meta-analysis of 62 randomized controlled trials.

Background: Heart failure following acute myocardial infarction (AMI) is a prevalent and severe cardiovascular complication, which markedly elevates the risks of mortality and readmission in affected patients. Although reperfusion therapy and standardized Western medical pharmacotherapy can ameliorate clinical prognosis, a subset of patients still progress to heart failure due to ventricular remodeling and sustained neuroendocrine activation. In recent years, traditional Chinese medicine injections (TCMIs) combined with conventional western medicine (CWM) have exhibited potential merits in enhancing cardiac function, suppressing inflammatory response and delaying ventricular remodeling. Nevertheless, systematic comparisons regarding the relative efficacy and safety of various combination regimens remain insufficient. Accordingly, it is essential to systematically assess the efficacy and safety of different TCMIs plus conventional therapy for heart failure post AMI. Methods: Electronic retrievals were performed across seven databases: China National Knowledge Infrastructure, VIP Database, Wanfang Data, Chinese Biomedical Literature Database, PubMed, Web of Science and Cochrane Library, with the retrieval period spanning from January 1, 2016 to June 1, 2026. Randomized controlled trials (RCTs) investigating TCMIs combined with conventional Western regimens for heart failure after acute myocardial infarction were enrolled. Stata and R statistical software were utilized to conduct network meta-analysis. Results: A total of 62 eligible RCTs containing 5922 participants and covering 8 varieties of TCMIs were ultimately included. Network meta-analysis (NMA) demonstrated that all eight TCMIs combination regimens could significantly raise clinical response rate, modulate indicators reflecting cardiac function and myocardial injury, decrease the concentrations of inflammatory factors, accompanied by low incidence rates of major adverse cardiovascular events (MACE) and adverse reactions. The results of the surface under the cumulative ranking curve (SUCRA) indicated that Shenfu Injection plus conventional Western therapy achieved the optimal efficacy in elevating cardiac output and stroke volume, as well as reducing N-terminal pro-B-type natriuretic peptide and tumor necrosis factor-α. Xinmailong Injection ranked favorably in lowering interleukin-6 and endothelin-1. Shenmai Injection obtained the highest SUCRA rankings in boosting left ventricular ejection fraction, ameliorating left ventricular end-systolic diameter, heart rate and B-type natriuretic peptide. Yiqi Fumai Injection presented superior rankings in improving cardiac index, diastolic blood pressure, creatine kinase isoenzyme-MB and reducing the occurrence of MACE. Xuebijing Injection occupied the top SUCRA position in improving overall clinical efficacy and decreasing cardiac troponin I and high-sensitivity C-reactive protein. Shuxuening Injection ranked first in adjusting left ventricular end-diastolic diameter and systolic blood pressure, while Huangqi Injection yielded the best outcomes in improving left ventricular end-systolic volume and Left Ventricular End-Diastolic Volume. All above findings were derived from indirect comparative evidence, requiring further verification via subsequent head-to-head direct comparative trials. Conclusion: Restricted by low-certainty evidence, all eight TCMIs combined with CWM can preliminarily improve clinical efficacy, optimize parameters of cardiac function and myocardial injury, and inhibit inflammatory levels in patients with heart failure post AMI, with mild MACE and adverse events. However, the evidence network in this analysis is predominantly star-shaped without closed loops, lacking direct head-to-head comparisons among distinct TCMIs. Additionally, the included trials are limited by small sample sizes, methodological flaws and substantial clinical heterogeneity. Therefore, the current outcomes merely serve as exploratory hypotheses rather than definitive clinical conclusions. Large-sample, multicenter and high-quality RCTs are still warranted to validate these preliminary findings and generate evidence-based references for individualized precise clinical medication. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261428750.