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Updated: Sep 19, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Impact of antiplatelet therapy on erectile dysfunction following percutaneous coronary intervention in patients with
Joongwon Choi1, Chung Un Lee1, Hyun Woong Park2
1Department of Urology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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 naïve 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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