Montorsi Piero, Ravagnani Paolo M, Galli Stefano, Rotatori Francesco, Veglia Fabrizio, Briganti Alberto, Salonia Andrea, Dehò Federico, Rigatti Patrizio, Montorsi Francesco, Fiorentini Cesare
Institute of Cardiology University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
Eur Heart J. 2006 Nov;27(22):2632-9. doi: 10.1093/eurheartj/ehl142. Epub 2006 Jul 19.
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).
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.
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.
根据临床表现、急性冠状动脉综合征（ACS）与慢性冠状动脉综合征（CCS）以及血管受累程度（单支血管病变与多支血管病变），调查冠心病（CAD）患者勃起功能障碍（ED）的患病率。
285例CAD患者分为三个年龄匹配组：第1组（G1，n = 95），ACS且单支血管病变（1-VD）；第2组（G2，n = 95），ACS且2、3支血管病变；第3组（G3，n = 95），慢性冠心病。对照组（C，n = 95）由疑似CAD但血管造影显示冠状动脉完全正常的患者组成。使用Gensini评分评估CAD的严重程度。根据国际勃起功能指数（IIEF），ED定义为任何小于26的值。由于Gensini评分所表示的动脉粥样硬化负担较轻[2（0 - 6）对40（19 - 68），P = 0.0001]，G1组的ED患病率低于G3组（22%对65%，P < 0.0001）。对照组的ED发生率与G1组相似（24%）。G2组的ED发生率、IIEF及Gensini评分与G1组有显著差异[55%，P < 0.0001；24（17 - 29），P = 0.0001；21（12.5 - 32），P < 0.0001]，与G3组相似，这表明尽管临床表现相似，但ACS患者的ED根据CAD的严重程度而有所不同。各研究组在传统危险因素的数量和类型上未发现显著差异。G3组使用β受体阻滞剂治疗的频率高于G1组和G2组。在G3组患有ED的患者中，93%的性功能障碍发作发生在CAD发作之前，平均时间间隔为24 [12 - 36]个月。在逻辑回归分析中，年龄（OR = 1.1；95%置信区间（CI），1.05 - 1.16；P = < 0.0001）、多支血管病变与单支血管病变（OR = 2.53；95% CI，1.43 - 4.51；P = 0.0002）以及CCS与ACS（OR = 2.32；95% CI，1.22 - 4.41；P = 0.01）是ED的独立预测因素。
CAD患者亚组中ED患病率不同，且与冠状动脉临床表现及CAD严重程度相关。在已确诊CAD的患者中，大多数情况下ED比CAD早出现平均2至3年。
