OBJECTIVE:

To assess the effectiveness and safety of acupuncture therapy for angina pectoris.

METHODS:

Randomized controlled trials (RCTs) concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier, MEDLINE, Science Citation Index Expanded, and three Chinese databases (China  biology medicine database, China national knowledge infrastructure, and  VIP database for Chinese technical periodicals). The valid data were  extracted in accordance with our inclusion and exclusion criteria. The  main outcomes of the included studies were synthesized using Revman 5.1.

RESULTS:

Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the standards of the  Cochrane Collaboration. Meta-analysis indicated that acupuncture  combined with conventional drugs (ACCD) was superior to conventional  drugs alone in reducing the incidence of acute myocardial infarction  (AMI) [OR = 0.18, 95% CI (0.04, 0.84), P = 0.03]. Moreover, ACCD was  superior to conventional drugs in the relief of angina symptoms [OR =  4.23, 95% CI (2.73, 6.56), P < 0.00001], and improvement of  electrocardiography (ECG) [OR = 2.61, 95% CI (1.83, 3.73), P <  0.00001]. Acupuncture by itself was also superior to conventional drugs  for angina symptoms [OR = 3.59, 95% CI (1.76,7.92), P = 0.0004] and ECG  improvement [OR = 3.07, 95% CI (1.54, 6.10), P = 0.001]. ACCD was  superior to conventional drugs in shortening the time to onset of angina relief [WMD = -1.40, 95% CI (-1.65, -1.15), P < 0.00001]. However,  the time to onset was significantly longer for acupuncture treatment  than for conventional treatment alone [WMD = 2.43, 95% CI (1.63, 3.23), P < 0.000 01].

CONCLUSION:

ACCD reduced the occurrence  of AMI, and both acupuncture and ACCD relieved angina symptoms and  improved ECG. However, compared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that  acupuncture is not suitable for emergency treatment of heart attack.  Owing to the poor quality of the current evidence, the findings of this  systematic review need to be verified by more RCTs to enhance  statistical power.