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Table 5 Summary of findings*

From: Effectiveness of acupuncture for angina pectoris: a systematic review of randomized controlled trials

Acupuncture for angina pectoris
Patient or population: patients with angina pectoris
Settings: Mainland China
Intervention: Acupuncture
Outcomes Illustrative comparative risks* (95% CI) Relative effect (95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments
Assumed risk Corresponding risk
  Control Acupuncture     
The number of patients showing ineffectiveness of angina relief (acupuncture plus medicines VS medicines) Study population RR 0.35 (0.25 to 0.48) 1002 (13 studies) very low1,2,3,6,7,8,9  
228 per 1000 75 per 1000 (52 to 107)
Moderate
425 per 1000 140 per 1000 (98 to 200)
The number of patients showing no ECG improvement (acupuncture plus medicines VS medicines) Study population RR 0.50 (0.40 to 0.62) 1035 (14 studies) very low1,2,3,6,7,8  
356 per 1000 178 per 1000 (142 to 220)
Moderate
238 per 1000 119 per 1000 (95 to 148)
The number of patients showing ineffectiveness of angina relief (acupuncture VS medicines) Study population RR 0.76 (0.53 to 1.09) 516 (7 studies) very low1,5,6,7,8  
216 per 1000 164 per 1000 (114 to 235)
Moderate
182 per 1000 138 per 1000 (96 to 198)
The number of patients showing no ECG improvement (acupuncture VS medicines) Study population RR 0.87 (0.65 to 1.16) 362 (6 studies) very low1,4,6,7,8  
426 per 1000 371 per 1000 (277 to 494)
Moderate
430 per 1000 374 per 1000 (279 to 499)
  1. *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
  2. GRADE Working Group grades of evidence.
  3. High quality: Further research is very unlikely to change our confidence in the estimate of effect.
  4. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
  5. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
  6. Very low quality: We are very uncertain about the estimate.
  7. 1The methodological quality of 24 trials was “high risk of bias” and 1 trials [35] “unclear risk of bias”; due to combining acupuncture treatment plus medicines versus medicines, it is difficult to blind acupuncturists and participants. Nine authors offered the details about the trials, but others have not been contacted;
  8. 2Inconsistency: Consider the forest plot (Figures 5 and 6), all studies on left side of the line of no effect, where the confidence intervals with minimal overlap, the p value for heterogeneity is greater than 0.05, and I2 is 0. All studies favor treatment. The quality of the evidence would not be downgraded for inconsistency based on the fact that the point estimates are compatible with benefit;
  9. 3large effect: In spite of large effect, the high risk bias threaten the validity;
  10. 4Inconsistency: Consider the forest plot (Additional file 6), with 6 studies, 4 on left and 2 on right side of the line of no effect, where the confidence intervals overlap, in which the p value for heterogeneity is larger than 0.05, I2 is 17%. Heterogeneity could not be explained by study design, differences in population/interventions/outcomes. All studies, except 1 favors treatment. The quality of the evidence would be downgraded for inconsistency;
  11. 5Inconsistency: Consider the forest plot (Additional file 4), with 7 studies, 5 on left and 1 on right side of the line of no effect, where the confidence intervals overlap, in which the p value for heterogeneity is larger than 0.05, I2 is 0%. All studies, except 1 favors treatment. The quality of the evidence would be downgraded for inconsistency. The quality of the evidence would not be downgraded for inconsistency based on the fact that the point estimates are compatible with no effect;
  12. 6Indirectness: The quality of the evidence may be downgraded when substitute measurements or surrogate endpoints are measured instead of patient-important outcomes, such as mortality, cardiovascular events;
  13. 7Imprecision: Total number of events is less than 300 (based on: Mueller et al. Ann Intern Med. 2007;146:878–881);95% confidence interval around the pooled effect includes both 1) no effect and 2) appreciable benefit or appreciable harm;
  14. 8Publication bias: see from funnel plot and potential language bias;
  15. 9Meta-analysis showed a better effect of acupuncture plus other interventions than other interventions on the outcomes of the number of patients showing ineffectiveness of angina relief and no ECG improvement.
  16. * It shows the quality of evidence for the outcomes of the number of patients showing ineffectiveness of angina relief and no ECG improvement.
  17. The “GRADEprofiler” was used to classify the comparisons of the combination of acupuncture with or without medicines and the medicines alone. We found the quality of evidence to be very low (see Table 5).