Introduction: Erectile dysfunction (ED) is common in men after myocardial infarction (MI) and is associated with poorer quality of life and systemic vascular disease. Previous studies have primarily relied on questionnaires, rarely including objective assessment of penile hemodynamics.

Objectives: To assess the quality of life in men with ED after MI treated with percutaneous coronary intervention (PCI) including routine assessment of penile hemodynamics using point‑of‑care resting Doppler ultrasonography.

Patients and methods: This observational, cross‑sectional, single‑center study included 600 men: 400 after MI treated with PCI and 200 without MI/PCI (controls). ED was assessed using the IIEF‑5 questionnaire, and quality of life was assessed using the SF‑36. Echocardiography, carotid Doppler ultrasound, and resting penile Doppler ultrasound were performed. Associations were analyzed using Spearman correlation and multivariate linear regression.

Results: All patients after MI had ED. Quality of life was significantly lower than in controls globally (SF‑36: 121.3 (8.9) vs. 134.6 (7.5); P <0.001) and in the physical and mental components. Penile Doppler parameters differed between groups and correlated with IIEF‑5. In multivariate analysis, the strongest predictor of quality of life was erectile function (IIEF‑5), followed by LVEF, BMI, heart rate, and vascular parameters (IMT, carotid and penile flow).

Conclusions: ED severity is a major independent determinant of quality of life in men after MI/PCI. Penile hemodynamic parameters reflect systemic vascular burden and functional status. Integrated ED assessment, including IIEF‑5 and routine resting penile Doppler ultrasound, can support risk stratification and post‑MI care.