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Acupuncture as Adjunctive Therapy for Chronic Stable AnginaA Randomized Clinical Trial

Educational Objective
To investigate the efficacy and safety of acupuncture as adjunctive therapy to antianginal therapies in reducing frequency of angina attacks in patients with chronic stable angina.
1 Credit CME
Key Points

Question  What is the efficacy and safety of acupuncture adjunctive therapy to antianginal therapies in reducing the frequency of angina attacks?

Findings  This randomized clinical trial that included 404 patients with chronic stable angina found that acupuncture on the acupoints in the disease-affected meridian significantly reduced the frequency of angina attacks compared with acupuncture on the acupoints on the nonaffected meridian, sham acupuncture, and no acupuncture.

Meaning  Adjunctive therapy with acupuncture had a significant effect in alleviating angina within 16 weeks.

Abstract

Importance  The effects of acupuncture as adjunctive treatment to antianginal therapies for patients with chronic stable angina are uncertain.

Objective  To investigate the efficacy and safety of acupuncture as adjunctive therapy to antianginal therapies in reducing frequency of angina attacks in patients with chronic stable angina.

Design, Setting, and Participants  In this 20-week randomized clinical trial conducted in outpatient and inpatient settings at 5 clinical centers in China from October 10, 2012, to September 19, 2015, 404 participants were randomly assigned to receive acupuncture on the acupoints on the disease-affected meridian (DAM), receive acupuncture on the acupoints on the nonaffected meridian (NAM), receive sham acupuncture (SA), and receive no acupuncture (wait list [WL] group). Participants were 35 to 80 years of age with chronic stable angina based on the criteria of the American College of Cardiology and the American Heart Association, with angina occurring at least twice weekly. Statistical analysis was conducted from December 1, 2015, to July 30, 2016.

Interventions  All participants in the 4 groups received antianginal therapies as recommended by the guidelines. Participants in the DAM, NAM, and SA groups received acupuncture treatment 3 times weekly for 4 weeks for a total of 12 sessions. Participants in the WL group did not receive acupuncture during the 16-week study period.

Main Outcomes and Measures  Participants used diaries to record angina attacks. The primary outcome was the change in frequency of angina attacks every 4 weeks from baseline to week 16.

Results  A total of 398 participants (253 women and 145 men; mean [SD] age, 62.6 [9.7] years) were included in the intention-to-treat analyses. Baseline characteristics were comparable across the 4 groups. Mean changes in frequency of angina attacks differed significantly among the 4 groups at 16 weeks: a greater reduction of angina attacks was observed in the DAM group vs the NAM group (difference, 4.07; 95% CI, 2.43-5.71; P < .001), in the DAM group vs the SA group (difference, 5.18; 95% CI, 3.54-6.81; P < .001), and in the DAM group vs the WL group (difference, 5.63 attacks; 95% CI, 3.99-7.27; P < .001).

Conclusions and Relevance  Compared with acupuncture on the NAM, SA, or no acupuncture (WL), acupuncture on the DAM as adjunctive treatment to antianginal therapy showed superior benefits in alleviating angina.

Trial Registration  ClinicalTrials.gov identifier: NCT01686230

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Article Information

Accepted for Publication: May 13, 2019.

Published Online: July 29, 2019. doi:10.1001/jamainternmed.2019.2407

Open Access: This article is published under the JN-OA license and is free to read on the day of publication.

Corresponding Authors: Fanrong Liang, MD (lfr@cdutcm.edu.cn), and Ling Zhao, PhD (zhaoling@cdutcm.edu.cn), Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shi’er Qiao Rd, Chengdu, Sichuan 610075, China.

Author Contributions: Drs Zhao and Liang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zhao, Zheng, Y. Li, Sun, Wu, Liang.

Acquisition, analysis, or interpretation of data: Zhao, D. Li, Chang, Cui, Wang, Shi, Fan, Sun, Zhang.

Drafting of the manuscript: Zhao, Zheng.

Critical revision of the manuscript for important intellectual content: D. Li, Chang, Cui, Wang, Shi, Fan, Y. Li, Sun, Zhang, Wu, Liang.

Statistical analysis: Zhang.

Obtained funding: Zhao, Liang.

Administrative, technical, or material support: Zhao, D. Li, Zheng, Chang, Cui, Wang, Shi, Fan, Y. Li, Sun, Liang.

Supervision: Zhao, Y. Li, Wu.

Conflict of Interest Disclosures: None reported.

Funding/Support: This trial was supported by grants 81590951, 81722050, and 81473603 from the National Natural Science Foundation of China and grant 2012CB518501 from the State Key Program for Basic Research of China.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3.

Additional Contributions: We thank all of the colleagues who were attending in this study and the research assistants, acupuncturists, and supporters of this study. Clinical data administration was performed by the Brightech-Magnsoft Data Services Company. The 5 clinical centers included the Hospital of Chengdu University of Traditional Chinese Medicine, the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Yunnan Province Hospital of Traditional Chinese Medicine, the First Affiliated Hospital of Guiyang University of Traditional Chinese Medicine, and the Affiliated Hospital of Shaanxi University of Chinese Medicine.

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