The Preventive Value of Acupoint Sensitization for Patients with Stable Angina Pectoris: A Randomized, Double-Blind, Positive-Controlled, Multicentre Trial

Background. Acupoint sensitization is considered an important factor in the efficacy of acupoint therapy. This study aimed to evaluate the efficacy of acupressure in the prevention of stable angina pectoris using acupoints with different pressure-pain sensitivities. Methods. A total of 202 patients were enrolled and randomly assigned to a high-sensitivity group (HSG) (n = 109) in which patients received acupressure at the five acupoints with the highest sensitivity to pain and a low-sensitivity group (LSG) (n = 93) in which patients received acupressure at the five acupoints with the lowest sensitivity to pain. The duration of acupressure treatment was 4 weeks, and the patients were evaluated at baseline, week 4, and week 8. The primary outcome was a change in the frequency of angina attacks from baseline. The secondary outcomes included nitroglycerin consumption, the Canadian Cardiovascular Society classification, and the Seattle Angina Questionnaire score. Adverse events such as bleeding and subcutaneous haemorrhage were recorded in both groups. Results. The effect of acupressure compared with baseline on the prevention of angina pectoris in HSG was better than that in LSG at week 4 (incidence rate ratio (IRR): 0.691 and 95% confidence interval (CI): [0.569, 0.839]) and week 8 (IRR: 0.692 and 95% CI: [0.569, 0.839]). No significant difference between groups was found in the frequency of nitroglycerin consumption at week 4 (odds ratio (OR) = 0.863 and 95% CI: [0.147, 5.077]) or week 8 (OR = 1.426 and 95% CI: [0.211, 9.661]). Two themes in the questionnaire showed significantly different changes from baseline between the two groups. Scores on the angina frequency (AF) subscale had changed more from the baseline in the HSG at week 8 than in the LSG (mean difference (MD) = 3.807 and 95% CI: [0.673, 6.942]). Scores on the treatment satisfaction (TS) subscale had also changed more in the HSG than in the LSG at week 4 (MD = 3.651 and 95% CI: [0.327, 7.327]) and week 8 (MD = 4.220 and 95% CI: [0.347, 7.346]). One patient in the LSG reported bruising at the acupoint. No unexpected safety problems arose. Conclusions. This study showed that acupressure at acupoints with high sensitivity to pain may effectively reduce the frequency of stable angina pectoris episodes. This trial is registered with NCT03975140.

P2685Improving myocardial perfusion in refractory angina: extracorporeal shockwave myocardial revascularization in a monocentric cohort

Background The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data and small clinical studies suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms in patients with RA. Purpose The aim of this study was to assess the efficacy of ESMR in the improvement of myocardial perfusion and symptoms in patients with RA. Methods Patients with RA despite optimal medical therapy and not suitable for further myocardial revascularization were enrolled and underwent ESMR. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiving ESMR the effect of on cardiac perfusion was assessed at six months. Results Among screened patients, 159 met the inclusion/exclusion criteria. 151 patients were enrolled in the present study and 121 treated with ESMR. There were 121 patients in the treatment group and 29 patients in the control group. The mean age of the patients was 70±8.8 years in the case group and 71±5.3 years in the control group. Other characteristics were similar in both groups. After ESMR myocardial perfusion by SPECT significantly improved: mean SSS was reduced from 21.2±9.42 to 14.2±10, with a 33% relative reduction (p=0.0001). Clinical follow up of both group demonstrated a significant improvement CCS class score at six months (1.5±0.6 in treatment and 1.92±0.69 in controls; p 0.0013) a significant improvement NYHA class score (1.4±0.6 in cases and 1.73±0.59 in controls; p 0.008); also, nitroglycerin consumption (29% in case cases, and 44.8% in controls; P 0.15) and hospitalization rate were reduced in the treatment group compared to control (16% vs. 37.9%; P 0.02). Clinical outcome of two groups at 6 months follow up Treatment group (n=121) Control group (n=29) p CCS class 1.5±0.6 1.92±0.7 <0.001 NYHA class 1.4±0.6 1.7±0.6 <0.008 Nitrates uptake 35 (29%) 13 (45%) <0.15 Admission to emergency department 20 (16%) 11 (38%) <0.02 SPECT results after 6 months follow up Conclusion ESMR therapy is a non-invasive safe and potentially effective new option for patients with refractory angina. This study confirms the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and hospitalizations in patients with refractory angina.