Acupuncture for Stable Angina Pectoris: A Systematic Review and Meta-Analysis

Abstract

Aim: To assess the efficacy and safety of acupuncture for treating patients with stable angina pectoris. Methods: Literature search was carried out in 9 electric databases from its inception to August 30, 2017. Relevant information was extracted for risk of bias assessment and data synthesis. The meta-analysis compared acupuncture with standard care alone/sham acupuncture. Primary outcome was angina attack frequency and nitroglycerin use. Secondary outcomes included pain intensity, 6-minute walk test (6MWT), ECG change, etc. The quality of evidence and the efficacy-effectiveness spectrum were rated based on the GRADE and the RITES/PRECIS-II, respectively. Results: 17 eligible trials with 1516 participants were included in this study. Risk of bias assessment suggested that the methodological design was inadequate for most trials and associated with unclear to high risk of selection and performance bias. Pooled data analysis demonstrated that acupuncture was more effective than standard care alone and/or sham acupuncture in reducing angina attack frequency (MD: -4.91, 95% CI [-6.01, -3.82], p<0.00001, I2=56%) and alleviating angina-related anxiety (MD: -0.96, 95% CI [-1.16, -0.75], p<0.00001, I2=20%) and depression (MD: -1.23, 95% CI [-1.47, -1.00], p<0.00001, I2=0%). Acupuncture has significantly improved patient’s ECG, 6-MWT and other patient-reported outcomes as compared with standard care alone, including the overall effectiveness (RR: 1.25, 95% CI [1.14, 1.37], p<0.00001, I2=0%), symptom relief (RR: 1.25, 95% CI [1.11, 1.39], p=0.0001, I2=0%) and the SAQ scores. However, nitroglycerin use and angina pain intensity didn’t show significant improvement after acupuncture treatment (p>0.05). The improvement of clinical outcomes seemed to be lower when acupuncture was compared to sham acupuncture than to standard care alone. No increased risk of adverse events was found in acupuncture. Conclusion: Acupuncture has the potential to be a safe and effective treatment for stable angina pectoris. More studies with sound methodological design are still needed.