Determinants of erectile dysfunction in the early phase after percutaneous coronary intervention: a prospective comparative analysis

Background/Introduction Erectile dysfunction (ED) may represent a silent and under-recognised symptom after percutaneous coronary intervention (PCI), particularly following myocardial infarction (MI). The underlying mechanisms, including the contribution of coronary burden, remain unclear. Purpose To prospectively evaluate determinants of erectile function at 3 months after PCI in MI and non-MI patients and to identify independent predictors of ED. Methods In this prospective observational study (Ethics approval No. 2025.10.39), consecutive male patients undergoing PCI were enrolled. Of 312 screened patients, 186 comprised the 3-month cohort (77 MI; 109 non-MI). Erectile function was assessed using the International Index of Erectile Function-5 at baseline and 3 months. Fear of sexual relations (FSR), demographic characteristics, cardiovascular risk factors, laboratory parameters, baseline SYNTAX score and residual SYNTAX score were analysed. Correlation and multivariable regression analyses were performed separately for MI and non-MI patients. Longer-term follow-up is ongoing. Results At 3 months, ED was more prevalent in MI than in non-MI patients (92.2% vs 79.8%). FSR showed a strong inverse correlation with erectile function in MI patients (rho = -0.692, p < 0.001) and a weaker association in non-MI patients (rho = -0.532, p < 0.001). In multivariable analysis including clinical and anatomical variables, FSR independently predicted worse erectile outcomes only in the MI group, whereas coronary anatomical indices were not significant determinants at this time point. Conclusion(s) ED after PCI, particularly following MI, appears to be influenced by fear of sexual relations within a multifactorial framework. Early sexual counselling and structured reassurance regarding safe resumption of physical and sexual activity may facilitate recovery.