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Piero Montorsi, Paolo M. Ravagnani, Stefano Galli, Francesco Rotatori, Fabrizio Veglia, Alberto Briganti, Andrea Salonia, Federico Dehò, Patrizio Rigatti, Francesco Montorsi, Cesare Fiorentini, Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial, European Heart Journal, Volume 27, Issue 22, November 2006, Pages 2632–2639, https://doi.org/10.1093/eurheartj/ehl142
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Abstract
Aims To investigate the prevalence of erectile dysfunction (ED) in patients with CAD according to clinical presentation, acute coronary syndrome (ACS) vs. chronic coronary syndrome (CCS), and extent of vessel involvement (single vs. multi-vessel disease).
Methods and results 285 patients with CAD divided into three age-matched groups: group 1 (G1, n=95), ACS and one-vessel disease (1-VD); group 2 (G2, n=95), ACS and 2,3-VD; group 3 (G3, n=95), chronic CS. Control group (C, n=95) was composed of patients with suspected CAD who were found to have entirely normal coronary arteries by angiography. Gensini's score used to assess extent of CAD. ED as any value <26 according to the International Index of Erectile Function (IIEF). ED prevalence was lower in G1 vs. G3 (22 vs. 65%, P<.0001) as a result of less atherosclerotic burden as expressed by Gensini's score [2 (0–6) vs. 40 (19–68), P=0.0001]. Controls had ED rate values similar to G1 (24%). Group 2 ED rate, IIEF, and Gensini's scores were significantly different from G1 [55%, P<0.0001; 24 (17–29), P=0.0001; 21 (12.5–32), P<0.0001] and similar to G3 suggesting that despite similar clinical presentation, ED in ACS differs according to the extent of CAD. No significant difference between groups was found in the number and type of conventional risk factors. Treatment with beta-blockers was more frequent in G3 vs. G1 and G2. In G3 patients who had ED, onset of sexual dysfunction occurred before CAD onset in 93%, with a mean time interval of 24 [12–36] months. In logistic regression analysis, age (OR=1.1; 95% confidence interval (CI), 1.05–1.16; P=<0.0001), multi-vessel vs. single-vessel (OR=2.53; 95% CI, 1.43–4.51; P=0.0002), and CCS vs. ACS (OR=2.32; 95% CI, 1.22–4.41; P=0.01) were independent predictors of ED.
Conclusion ED prevalence differs across subsets of patients with CAD and is related to coronary clinical presentation and extent of CAD. In patients with established CAD, ED comes before CAD in the majority by an average of 2 up to 3 years.
