Impact of antiplatelet therapy on erectile dysfunction following percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

초록

Background: Acute myocardial infarction (AMI) is strongly associated with erectile dysfunction (ED). This study evaluated the association between P2Y12 receptor inhibitor type and ED, and factors associated with moderate-to-severe ED in high-risk patients with AMI. Methods: The HEALING-AMI trial randomized patients with na & iuml;ve ST-segment elevation myocardial infarction (STEMI) to dual antiplatelet therapy (DAPT) with either ticagrelor or clopidogrel. This substudy included 59 male patients who completed 6 months of DAPT (ticagrelor, n = 30; clopidogrel, n = 29). Erectile function [International Index of Erectile Function-5 (IIEF-5)], Bleeding Academic Research Consortium (BARC) bleeding, and dyspnoea were assessed using standardized questionnaires. Results: At 6-month follow-up, moderate-to-severe ED (IIEF-5 <= 11) and bleeding episodes (predominantly BARC type 1) were observed in 47.5% and 54.2%, respectively. Compared with clopidogrel, ticagrelor was associated with a lower IIEF-5 score (9.7 +/- 8.8 vs. 17.0 +/- 7.8, p = 0.002) and lower platelet reactivity [32 +/- 67 vs. 146 +/- 55 P2Y12 reaction units (PRU) measured by VerifyNow, p < 0.001]. Moderate-to-severe ED was more common in patients treated with ticagrelor than in those treated with clopidogrel (63.3% vs. 31.0%). Bleeding episodes and platelet reactivity were also significantly associated with moderate-to-severe ED. In multivariable analysis, both P2Y12 inhibitor type and bleeding episodes were independently associated with moderate-to-severe ED. After multivariable adjustment, ticagrelor-treated patients who experienced bleeding had an approximately 5.6-fold higher odds of moderate-to-severe ED than clopidogrel-treated patients without bleeding (95% CI 1.052-30.087, p = 0.044). Conclusions: In male patients with STEMI, moderate-to-severe ED and bleeding episodes were common during DAPT. P2Y12 inhibitor type (ticagrelor vs. clopidogrel) and bleeding episodes were associated with moderate-to-severe ED.

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