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A Retrospective Cohort Study Comparing Stroke Recurrence Rate in Ischemic Stroke Patients With and Without
Chun-Chuan Shih1, Chien-Chang Liao, Mao-Feng Sun
1From the School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung (CCS); Ph.D. Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University (CCS); Department of Anesthesiology, Taipei Medical University Hospital, Taipei (CCL); School of Chinese Medicine, (CCL, MFS, YCS, JGL); Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan (CPW, CYH); Fielding School of Public Health, University of California, Los Angeles, California (DEM); Department of Public Health, China Medical University (FCS); and Department of Neurology, China Medical University Hospital, Taichung, Taiwan (CYH).
Abstract:
Little was known about the effects of acupuncture on stroke recurrence. The aim of this study is to investigate whether ischemic stroke patients receiving acupuncture treatment have a decreased risk of stroke recurrence. A retrospective cohort study of 30,058 newly diagnosed cases of ischemic stroke in 2000 to 2004 was conducted based on the claims of Taiwan National Health Insurance Research Database. The use of acupuncture treatment and stroke recurrence were identified during the follow-up period from 2000 to 2009. This study compared the risk of stroke recurrence between ischemic stroke cohorts with and without acupuncture treatment by calculating adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acupuncture associated with stroke recurrence in the Cox proportional hazard model. The stroke recurrence rate per 1000 person-years decreased from 71.4 without to 69.9 with acupuncture treatment (P < 0.001). Acupuncture treatment was associated with reduced risk of stroke recurrence (HR 0.88; 95% CI 0.84-0.91). The acupuncture effect was noted in patients with or without medical treatment for stroke prevention but its impact decreased with aging of stroke patients. Compared with stroke patients without acupuncture treatment and medication therapy, the hazard ratios of stroke recurrence for those had medication therapy only, acupuncture only, and both were 0.42 (95% CI 0.38-0.46), 0.50 (95% CI 0.43-0.57), and 0.39 (95% CI 0.35-0.43), respectively. This study raises the possibility that acupuncture might be effective in lowering stroke recurrence rate even in those on medications for stroke prevention. Results suggest the need of prospective sham-controlled and randomized trials to establish the efficacy of acupuncture in preventing stroke.
