Efficacy of Acupuncture as Complementary Therapy for Refractory Angina Pectoris: A Systematic Review

Introduction: Refractory angina pectoris poses a major public health challenge due to its effects on patients' quality of life, the significant healthcare costs involved, and its increasing prevalence among the aging population with coronary artery disease. This systematic review evaluates the efficacy of acupuncture as an adjunct therapy for this condition, particularly in reducing the frequency of angina attacks, the usage of nitroglycerin as a rescue medication, and pain intensity.  Methods: The systematic review included randomized controlled trials (RCTs) published up to July 13, 2024, comparing any modality of acupuncture combined with conventional treatment versus conventional treatment alone, sham acupuncture, or non-meridian acupuncture. The inclusion criteria comprised adults diagnosed with stable angina pectoris for at least three months, experiencing angina more than once a week, and undergoing treatment for at least four weeks. Exclusions were applied for patients with severe cardiovascular or systemic conditions, pregnant or lactating women, and studies with incomplete data. Literature searches were conducted using PubMed, Cochrane Library, LILACS, Google Scholar, and Embase, with the risk of bias assessed via the Cochrane ROB2 tool.  Results: Five RCTs involving participants of Chinese ethnicity were analyzed. Results indicated that acupuncture significantly reduced the frequency of angina attacks and improved the Seattle Angina Questionnaire scores and pain intensity as measured by the Visual Analogue Scale (VAS).  Conclusion: Acupuncture could be effective as an adjunctive treatment for refractory angina pectoris. However, limitations due to sample size and generalizability necessitate further studies to corroborate these findings and assess long-term effectiveness.