The Prognostic Role of Residual SYNTAX Score in the Recovery of Erectile Function Following Myocardial Infarction Treated with Percutaneous Coronary Intervention.

Abstract

Background: Erectile dysfunction (ED) and acute coronary events are closely linked, yet the trajectory of ED following percutaneous coronary intervention (PCI) remains incompletely understood. The residual SYNTAX score (RSS) quantifies incomplete revascularization and is an established prognostic tool in cardiology; however, its role in erectile function recovery after myocardial infarction (MI) is unclear.

Objectives: To evaluate whether RSS predicts recovery of erectile function after MI treated with PCI.

Materials and methods: In this prospective cohort study, 82 men aged 40-70 years who underwent PCI for MI were evaluated. ED was assessed using the International Index of Erectile Function-5 (IIEF-5) at baseline (after recovery from PCI, reflecting erectile functions before MI), and at 3 and 6 months. ED was defined as an IIEF-5 score ≤21. Patients were stratified according to RSS (<8 vs. ≥8). Anxiety (sexual-fear subscale) and depressive symptoms (BDI-II) were also assessed.

Results: ED was present in 57.3% of patients at baseline, increased to 68.7% at 3 months, and decreased to 37.3% at 6 months. At 6 months, mean IIEF-5 scores improved significantly in men with RSS <8 (from 17.9 to 21.2; p < 0.001), but not in those with RSS ≥8 (from 17.2 to 16.3; p = 0.314). While severe ED remained largely unchanged over time, mild-to-moderate ED demonstrated the greatest improvement. Anxiety independently predicted ED at 3 months (OR 1.223, p = 0.049). At 6 months, RSS ≥8 independently predicted persistent ED (OR 3.22, p = 0.033), with moderate discriminatory accuracy (AUC 0.72).

Conclusion: RSS ≥8 may identify men at increased risk for persistent ED after MI. The differential recovery patterns suggest that reversible functional impairment may predominate in milder forms of ED, whereas persistent severe ED may reflect more extensive systemic and penile vascular disease. Early recognition of anxiety and targeted sexual counseling may support erectile recovery following PCI.