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European Heart Journal Advance Access published online on July 19, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl142
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received December 15, 2005
Revised May 10, 2006
Accepted June 14, 2006

Clinical research

Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial

Piero Montorsi 1 *, Paolo M. Ravagnani 1, Stefano Galli 1, Francesco Rotatori 1, Fabrizio Veglia 1, Alberto Briganti 2, Andrea Salonia 2, Federico Dehò 2, Patrizio Rigatti 2, Francesco Montorsi 2, and Cesare Fiorentini 1

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

* To whom correspondence should be addressed.
Piero Montorsi, E-mail: piero.montorsi{at}unimi.it


  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.

Keywords: Erectile dysfunction; Coronary artery disease; Acute coronary syndrome; Gensini's score; Chronic coronary syndrome.
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