European Heart Journal Advance Access originally published online on July 19, 2006
European Heart Journal 2006 27(22):2632-2639; doi:10.1093/eurheartj/ehl142
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Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial
1 Institute of Cardiology University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
2 Department of Urology and Sexual Diseases, University Vita-Salute Ospedale S.Raffaele, Milan, Italy
Received 15 December 2005; revised 10 May 2006; accepted 14 June 2006; online publish-ahead-of-print 19 July 2006.
* Corresponding author. Tel: +39 02 58002576; fax: +39 02 58002398.E-mail address: piero.montorsi{at}unimi.it
See page 2613 for the editorial comment on this article (doi:10.1093/eurheartj/ehl110)
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.
Key Words: Erectile dysfunction • Coronary artery disease • Acute coronary syndrome • Gensini's score • Chronic coronary syndrome
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