관상동맥 중재술을 받은 환자에서 실로스타졸 사용 후 동맥경직도의 변화
The Effect of Cilostazol on Arterial Stiffness in Patients Undergoing Percutaneous Coronary Intervention
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목적: 동맥경직도의 증가는 심혈관질환의 위험인자로 잘알려져 있다. 실로스타졸은 phosphodiesterase type 3 억제제로, 혈관 확장 및 혈관 보호 효과를 보이는 항혈소판제이다. 이에 본 저자들은 실로스타졸이 동맥경직도에 어떤 영향을 주는지 알아보고자 하였다. 방법: 허혈성심질환의 치료를 위하여 관상동맥중재술을받은 환자 161명(남자 112명, 평균 63세)을 순차적으로 본 연구에 등록하였다. baPWV, rAI, rAI75, cSBP와 cPP값을 측정하였다. 기저치와 30일 후 값을 얻어 변화량을 구하였다. 실로스타졸을 추가로 사용한 실로스타졸군과 표준치료를 받은대조군으로 나누어 비교 분석하였다. 결과: 30일 경과 후 실로스타졸군에서 rAI와 cSBP, cPP가호전되었다. 대조군은 이들 지표의 의미 있는 변화가 없었다. rAI75와 baPWV의 값은 두 군에서 차이가 없었다. rAI와 cSBP, cPP는 bSBP, bDBP, 심박수의 변화와 상관관계를 보였고, 실로스타졸의 사용 및 베타차단제의 사용과 관련 있었다. rAI, cSBP와 cPP에 대한 다변량분석에서 실로스타졸이 독립적 영향인자였다. 결론: 관상동맥중재술을 받은 환자에서 실로스타졸의 추가 사용하여 30일 후 rAI와 cSBP, cPP가 호전되었다. rAI75와baPWV의 호전은 없었기 때문에 실로스타졸에 의한 심박수증가에 의한 효과로 생각해 볼 수 있다.
Abstract
Background/Aims: Increased arterial stiffness is a well-known risk factor for cardiovascular disease. Cilostazol, a phosphodiesterase type 3 inhibitor, is a unique antiplatelet agent with vasodilatory and vasoprotective effects. Therefore, we hypothesized that cilostazol may affect arterial stiffness. Methods: We enrolled 161 patients (112 males; mean age, 63 years) who had undergone percutaneous coronary intervention (PCI) for ischemic heart disease. The brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), rAI adjusted for a heart rate of 75 beats/min (rAI75), central systolic blood pressure (cSBP), and central pulse pressure (cPP), were measured at baseline and at the 30-day follow-up. Parameter changes were compared between the cilostazol group (n = 51) and the control group (n = 110). Results: In the cilostazol group, the values for rAI, cSBP, and cPP all improved after 30 days, while the control group displayed no significant interval changes in these parameters. The changes in rAI75 and baPWV did not differ significantly between the two groups. The changes in rAI, cSBP, and cPP were related to brachial systolic blood pressure, brachial diastolic blood pressure, heart rate, and the use of cilostazol and beta-blockers. In a multivariate analysis, the use of cilostazol was identified an independent factor associated with changes in rAI, cSBP, and cPP.Conclusions: The addition of cilostazol to conventional antiplatelet therapy in patients undergoing PCI may be associated with improvements in rAI, cSBP, and cPP, but not in rAI75 or baPWV. Therefore, the effects of cilostazol might be related to an increased heart rate.
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