Neuroprotection via optimizing cerebral blood flow after cardiac arrest (neuro-intact) study - A phase II proof-of-concept study protocol.

Sexual activity is an important component of quality of life for patients after myocardial infarction (MI). However, resuming sexual intercourse often raises concerns among both patients and healthcare providers. Available data indicate that after an uncomplicated MI, sexual activity can usually be resumed after approximately 1–2 weeks, provided there are no cardiac symptoms during mild to moderate physical activity. According to the Princeton III Conference recommendations, resuming sexual intercourse may be considered approximately 3 weeks after the event, especially in patients with a negative exercise test without evidence of myocardial ischemia. The exertion associated with sexual activity corresponds to a workload of approximately 3–5 metabolic equivalents of exercise (METs). Patients able to achieve this level of exercise without symptoms are considered at very low risk of cardiovascular events. Current guidelines emphasize the need for individualized decisions regarding resuming sexual activity, taking into account clinical stability, exercise capacity, and the course of cardiac treatment. Cardiac rehabilitation and structured counseling for patients play an important role in this respect [, ]. Phosphodiesterase type 5 inhibitors (PDE5i) are considered safe in most patients with stable coronary artery disease and do not appear to increase the risk of cardiovascular events. However, their concomitant use with nitrates remains contraindicated due to the risk of severe hypotension [, ]. Erectile dysfunction (ED) is common in patients with coronary artery disease, after acute coronary syndrome, or after percutaneous coronary intervention (PCI), with a prevalence estimated at approximately 64–90%, depending on the population studied. It is increasingly recognized as an early manifestation of systemic endothelial dysfunction and atherosclerosis. Impaired nitric oxide bioavailability and endothelial dysfunction play a central role in both coronary artery disease and ED, linking these conditions at the pathophysiological level. According to the “artery size hypothesis”, smaller penile arteries may become symptomatic earlier than coronary vessels, making ED a potential early clinical marker of subclinical atherosclerosis. Moreover, new ED after a first myocardial infarction often appears in the first months after the event and is strongly associated with age and the presence of comorbidities, especially diabetes [–]. Observational study data indicate a persistent gap in sexual counseling following myocardial infarction or PCI, even though patients often expect clear information regarding the safe return to sexual intercourse []. Pharmacotherapy administered after myocardial infarction or PCI may affect erectile function, and in the case of ED in cardiac patients, treatment modifications may be possible while maintaining safety [, ]. Despite the growing number of publications on sexual function in patients with coronary artery disease, relatively few studies have simultaneously assessed the incidence of ED, the level of anxiety associated with sexual activity, and the scope of sexual health counseling in the early post-myocardial infarction period, especially in the PCI patient population.