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

Objective To evaluate the long-term efficacy and safety of the Astragalus-Salvia miltiorrhiza (ASM) botanical drug pair as an adjunctive therapy for stable coronary artery disease (SCAD) and to develop a prognostic nomogram for frequent readmissions. Methods 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 (≥3 times), and symptom networks were analyzed via the Apriori algorithm to evaluate symptom alleviation. Results 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 P P > 0.05). Notably, stroke history emerged as the primary independent risk factor ( P Conclusion 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. Clinical Trial Registration https://itmctr.ccebtcm.org.cn/mgt/dashboard , identifier TMCTR2025000058.