Hannes Franz Alber

• Assoc. Prof.
• Head of Department at Klinikum Klagenfurt Am Wörthersee

Aim Cirrhotic cardiomyopathy is characterised by myocardial dysfunction in patients with cirrhosis in the absence of other cardiac conditions. We aimed to develop and validate a scoring system to identify patients at high risk for reduced global longitudinal strain, a newly proposed marker of myocardial dysfunction in the updated diagnostic criteri...

Background Empagliflozin administered after acute myocardial infarction proofed to improve cardiometabolic parameters and biomarkers, but the impact on cardiac function is still largely unknown. The aim of this post-hoc echocardiographic sub-analysis of the EMMY trial was to provide in-depth echocardiographic analysis on the effects of empagliflozi...

Introduction Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite sev...

Introduction Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review s...

Aim We aimed to present an overview of changes in daily practice of primary PCI in relation to on the growing evidence in device and adjunctive pharmacologic therapy. Methods and results Clinical outcomes, data on treatment as well as characteristics of 19,054 patients prospectively enrolled in a nation-wide registry of primary PCI between 2005 an...

This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative...

Perioperative myocardial injury (PMI) is a common complication after non-cardiac surgery and is associated with high postoperative mortality. The current ESC guidelines on the perioperative management of patients undergoing non-cardiac surgery recommend routine perioperative troponin surveillance before medium- and high-risk non-cardiac surgery in...

Objective: The low-density lipoprotein cholesterol goals in the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines necessitate greater use of combination therapies. We describe a real-world cohort of patients in Austria and simulate the addition of oral bempedoic acid and ezetimibe to estimate the proport...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): ZOLL Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Exercise training a...

Patients with acute myocardial infarction are at high risk for developing heart failure due to scar development. Although regenerative approaches are evolving, consistent clinical benefits have not yet been reported. Treatment with dutogliptin, a second-generation DPP-4 inhibitor, in co-administration with filgrastim (G-CSF) has been shown to enhan...

BACKGROUND AND AIMS Sodium–glucose co-transporter 2 inhibition reduces the risk of hospitalisation for heart failure and for death in patients with symptomatic heart failure. However, trials investigating the effects of this drug class in patients following acute myocardial infarction are lacking. METHODS In this academic, multicentre, double-blin...

Funding Acknowledgements Type of funding sources: None. Background Patients are at elevated risk of sudden cardiac death (SCD) after acute myocardial infarction (MI). The VEST trial failed to show a significant reduction in arrhythmic mortality in patients prescribed with a wearable converter-defibrillator (WCD), having a lower than expected weari...

Calibration is a vital aspect of the performance of risk prediction models, but research in the context of ordinal outcomes is scarce. This study compared calibration measures for risk models predicting a discrete ordinal outcome, and investigated the impact of the proportional odds assumption on calibration and overfitting. We studied the multinom...

supplement https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1002%2Fsim.9281&file=sim9281-sup-0001-supinfo.pdf

Background and aim: Sodium glucose cotransporter 2 (SGLT2) have proven profound positive effects in heart failure with reduced ejection fraction (HFrEF). These effects are independent from the presence of diabetes. Metabolic effects, anti-inflammatory, and anti-fibrotic properties are discussed as underlying mechanisms. Despite a strong correlation...

supplement to "Risk prediction models for discrete ordinal outcomes: calibration and the impact of the proportional odds assumption"

Background SARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin–angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE-inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) mitigates the course o\f recent-onset CO...

Background: Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patien...

Calibration is a vital aspect of the performance of risk prediction models, but research in the context of ordinal outcomes is scarce. This study compared calibration measures for risk models predicting a discrete ordinal outcome, and investigated the impact of the proportional odds assumption on calibration and overfitting. We studied the multinom...

Background & Aims Recently published criteria by 2019 Cirrhotic Cardiomyopathy Consortium set a lower threshold for reduced ejection fraction to diagnose systolic dysfunction in cirrhotic patients, and stress testing was replaced by echocardiography strain imaging. The criteria to diagnose diastolic dysfunction are in general concordant with the 20...

Background Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited. Purpose To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI. Methods and resu...

Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and/or for patients in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Purpose To investigate incidence and predictors of appropriate WCD shocks. Methods We performe...

Heart failure (HF) is common and is associated with high morbidity, mortality and high health expenditure. A multidisciplinary disease management plan (DMP) can reduce morbidity and mortality, save costs and improve the quality of life. In Austria, three HF-specific DMPs are currently in a project phase and four established DMPs are active. Althoug...

The new ESC guidelines for „The Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk“stand in the foreground of this update and may help to realize these new specifications in clinical practice.

Background: Sodium glucose cotransporter 2 (SGLT2) inhibitors are established antidiabetic drugs with proven cardiovascular benefit. Although growing evidence suggests beneficial effects on myocardial remodeling, fluid balance and cardiac function, the impact of empagliflozin initiated early after acute myocardial infarction (AMI) has not been inv...

Background The wearable cardioverter-defibrillator (WCD) is a treatment option for patients at high risk for ventricular arrhythmia, either if the risk is potentially reversible or if an implantable cardioverter defibrillator (ICD) implantation is currently not possible. Methods We performed a retrospective analysis of all alarms in the cohort of...

Background Dual antiplatelet therapy (DAPT) prevents thrombotic events after coronary stent implantation but may induce bleedings, specifically in elderly patients. However, a competitive risk analysis is lacking. Objectives To assess the determinants of major bleeding and the balance between the competing risks of major bleeding and thrombotic ev...

Appendix 1 Authors and BASKET-PROVE II Investigators. (DOCX)

Study protocol BASKET PROVE II. (PDF)

Duration and compostion of dual antiplatelet therapy has been increasingly changed within the past few years as also indicated in the firmer ESC guidelines. The current manuscript summarizes the most important changes in dual antiplatelet therapy as shown by a recent ESC position paper and offers quick insight into these new developments.

The extent of coronary artery disease (CAD) is relevant for the evaluation and the choice of treatment of patients and consists of the severity of stenoses and their distribution within the coronary tree. Diagnosis is not easy and severe CAD should not be missed. For low-risk patients one wants to avoid the invasive angiography. We aim to propose a...

Purpose: With the Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort it is aimed to gain a better understanding of cardiovascular risk factors and their relation to the diagnosis and the severity of coronary artery disease, as well as to the long-term prognosis in consecutive (including revascularis...

Randomized controlled trials have shown conflicting results regarding outcome of bivalirudin in primary PCI (PPCI). The aim of this study was to evaluate in-hospital outcome of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between Januar...

Background: Spasticity is a very common syndrome in patients with multiple sclerosis (pwMS), but available treatments lead to sufficient symptom control only in one third. Objective: To investigate the impact of an individualized training program on improving spasticity in a prospective pilot trial in pwMS suffering from moderate spasticity (define...

Background The two newer oral P2Y12 inhibitors prasugrel and ticagrelor have proven superior to clopidogrel in the treatment of acute coronary syndrome (ACS). The extent to which the reduction in mortality seen with ticagrelor is confined to this particular agent is hard to judge by simply looking at the overall study results as the study populatio...

Objective: To externally validate and extend a recently proposed prediction model to diagnose obstructive coronary artery disease (CAD), with the ultimate aim to better select patients for coronary angiography. Design: Analysis of individual baseline data of a prospective cardiology cohort. Setting: Single-centre secondary and tertiary cardiol...

Das über Jahre langfristig erhöhte kardiovaskuläre Risiko von Patienten/innen mit einem akuten Koronarsyndrom (ACS) ist eine Herausforderung. Rezente Resultate für eine über ein Jahr hinaus prolongierte duale Antiplättchentherapie haben einen ischämische Nutzen zum Preis einer erhöhten Blutungsgefahr aufgezeigt. Daher ist eine individuelle, sorgfäl...

Aims: The British National Institute of Clinical Excellence (NICE) guidelines recommend to use DES instead of BMS only in lesions >15mm in length or in vessels < 3mm in diameter. We analysed the impact of stent length and stent diameter on ISR in the BASKET-PROVE study population and evaluated the cost-effectiveness of DES compared to BMS. Method...

Predicting obstructive coronary artery disease (CAD) in patients involves a thorough assessment of symptoms and risk factors (including possibly results of noninvasive imaging modalities or stress tests) before an invasive coronary angiography (CA) is performed. To avoid unnecessary invasive and expensive procedures, a good estimation of disease pr...

Purpose: To investigate the effect of P2Y12 receptor inhibitor pre-treatment in a real world setting of primary PCI (pPCI) after the implementation of prasugrel and ticagrelor. Methods: 6325 consecutively enrolled patients from a nationwide registry undergoing pPCI between 2011 and 2014 were grouped according to P2Y12 inhibitor treatment start into...

To the Editor: In the article by Ohman on chronic stable angina (March 24 issue),(1) some antianginal strategies were not adequately addressed. First, the recommendation for lifestyle changes did not include the potential effects of exercise training, although studies have shown a benefit with respect to mortality, morbidity, and quality of life.(2...

The protective effect of dual antiplatelet therapy (DAPT) following acute coronary syndrome is undisputed, but its duration is subject of debate. Several studies show that prolonged therapy provides a clinical benefit in patients following acute coronary syndrome. The aim of this position paper authored by Austrian experts is to outline the current...

Background: Drug-eluting stents (DES) improve outcomes in elderly patients with small coronary artery disease compared with bare-metal stents (BMS), but randomized data in elderly patients in need of large coronary stents are not available. Methods: Planned secondary analysis of patients ≥75 years recruited to the "BASKET-PROVE" trial, in which...

The phenotype pantoprazole-<13>C breath test (Ptz-BT) was used to evaluate the extent of phenoconversion of cytochrome P450 2C19 (CYP2C19) caused by commonly prescribed proton pump inhibitors (PPI) omeprazole and esomprazole. A single center open label three visit study with 26 healthy volunteers and 8 stable cardiovascular patients was conducted f...

-Biodegradable-polymer drug-eluting stents (BP-DES) were developed to be as effective as second-generation durable-polymer drug-eluting stents (DP-DES) and as safe >1 year as bare-metal stents (BMS). Thus, very late stent thrombosis (VLST) attributable to durable polymers should no longer appear. -To address these early and late aspects, 2291 patie...

Background: Women undergoing coronary angiography (CA) due to chest pain are more likely to present with less extensive coronary artery disease (CAD) than men, which might be attributed to different effects of cardiovascular risk factors on coronary atherogenesis between sexes. The aim of the present study was to evaluate sex differences in indepe...

Aims: The use of drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet endorsed in clinical guidelines. Methods and results: This was an a priori planned post hoc analysis involving 754 NSTE-ACS patients from the randomised BASKET-PROVE trial (sirolimus-eluting stent vs....

Aim: Data regarding the prognostic value of peripheral endothelial function testing in patients with cardiovascular disease are conflicting. Peripheral arterial tonometry(PAT) is increasingly used to measure the peripheral endothelial function. The prognostic value of this method has not been investigated thus far in patients with cardiovascular d...

Angesichts der demografischen Bevölkerungsentwicklung ist die Kardiologie immer häufiger aufgefordert, sich mit Therapieentscheidungen bei hochbetagten Menschen zu beschäftigen. Dabei sind neben Komorbiditäten stets auch Patientenwünsche besonders zu berücksichtigen. Therapieziele verlagern sich mit zunehmendem Alter regelmäßig von Morbiditäts- bzw...

To investigate the importance of vessel size on outcome differences by comparing the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) in women and men with large coronary vessels. All 2314 BASKET-PROVE patients randomized to DES versus BMS were followed for 2years with a primary endpoint of major adverse cardiac events (MACE: car...

Aims: To scrutinize "limitations" of Drug-Eluting Stent (DES) use in contemporary "all-comer DES" practice responsible for continued Bare-Metal Stent (BMS) usage of 20-30%, i.e. contraindications to DES/double-antiplatelet therapy and limited DES benefits assumed in certain patient subgroups. Methods and results: A prospective registry of patients...

Introduction: The advantage of drug eluting stents (DES) compared to bare metal stents (BMS) is small for the the risk of in-stent-restenosis (ISR) in short lesions of large coronary arteries. Therefore, the British National Institutes of Clinical Excellence (NICE) guidelines recommend to use BMS instead of DES in lesions < 15mm in length and > 3mm...

Purpose: Standard 12-lead ECG shows low sensitivity to detect acute myocardial infarction (MI) related to the circumflex artery and data on primary PCI in affected patients (pts.) is rare. We aimed to investigate characteristics and outcome in pts. with ST-elevation MI undergoing primary PCI according to the infarct-related artery (IRA). Methods: W...

Purpose: To assess the optimal duration of Dual Antiplatelet Therapy (DAPT) after coronary stent implantation. Methods: Two subsequent trials with similar inclusion criteria but different DAPT duration (BASKET 6 versus BASKET-PROVE 12 months) were evaluated. Definite/probable Stent Thrombosis (ST) and Major Bleedings (MB, defined as TIMI 3 and BARC...

Elevated heart rate (HR) is associated with mortality in a number of heart diseases. We examined the long-term prognostic significance of HR at discharge in a contemporary population of patients with stable angina (SAP), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) revasculariz...

Aims: Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. Methods and results: In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥...

The last decade was marked by profound changes in the interventional armamentarium and pharmacological co-therapies of patients undergoing percutaneous coronary interventions. Innovations in stent design and interventional techniques as well as novel antiplatelet agents and anticoagulants led to significant improvements in clinical outcomes and con...

Endothelial dysfunction represents an early step in atherogenesis, and can be non-invasively measured in peripheral vessels. The most common used technique to assess peripheral endothelial function is the ultrasound-based measurement of flow mediated di-ation (FMD) of the brachial artery. However, this method lacks in standardization and has a well...

Background: Weather conditions influence symptoms in chronic stable coronary artery disease (CAD). Whether the ongoing climate change, with continuous and rapid temperature increases, also has an impact on the incidence and outcome of non-ST elevation (NSTEMI) and ST elevation (STEMI) myocardial infarctions referred for acute coronary angiography...

To the Editor Rehabilitation after myocardial infarction trial (RAMIT) explored the effect of a phase II outpatient-based cardiac rehabilitation (CR) concept. The authors reported no effect on mortality, cardiac or psychological morbidity, risk factors, health-related quality of life or physical activity of a comprehensive CR programme after myocar...

In the BAsel Stent Kosten Effektivitäts Trial PROspective Validation Examination (BASKET-PROVE), drug-eluting stents (DESs) had similar 2-year rates of death and myocardial infarction but lower rates of target vessel revascularization and major adverse cardiac events compared with bare-metal stents (BMSs). However, comparative clinical effects of n...

For many years vitamin K antagonists have been the "gold- standard" for effective stroke prevention in patients with nonvalvular atrial fibrillation. The search for more practicable and similarly effective oral anticoagulants not only fulfilled but also surpassed the expectations in form of the direct oral antithrombin dabigatran (RE-LY study) as w...

Beside an improved neurological outcome after cardiac arrest, a mild therapeutic hypothermia is associated with a reduced infarct size in animal models of myocardial infarction. According to subanalyses of the two first negative trials in humans (COOL-MI and ICE-IT) a prerequisite for the benefit seems to reach the target temperature of ≤ 35°C at t...

Endothelial dysfunction represents an early step in atherogenesis, and can be non-invasively measured in peripheral vessels. The most common used technique to assess peripheral endothelial function is the ultrasound-based measurement of flow mediated dilation (FMD) of the brachial artery. However, this method lacks in standardization and has a well...

A 44-year old woman was admitted to hospital with an acute coronary syndrome ten days after an acute thoracic trauma. The promptly performed coronary angiography showed plane coronary arteries. Due to the hypokinetic anterior wall a Tako-Tsubo cardiomyopathy was supposed. A few days later the patient again emerged massive chest pain and ST-segment...

The aim of the study was to compare N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, and gamma-glutamyl transferase (γ-GT) with traditional risk markers for estimating prognosis in patients with stable coronary artery disease (CAD). Evaluation of mortality and a combined clinical endpoint (mortality, need...

Aims Pre-treatment with clopidogrel results in a reduction of ischaemic events in non-ST-elevation acute coronary syndromes. Data on upstream clopidogrel in the setting of primary percutaneous coronary intervention (PCI) are limited. The aim of this study was to investigate whether clopidogrel loading before arrival at the PCI centre may result in...

The best second arterial conduit for multiple arterial revascularization (MAR) is still a matter of debate. Previous studies on the benefit of either using the radial artery (RA) or the right internal thoracic artery (RITA) in coronary artery bypass grafting are not conclusive. The aim of our study was to compare the perioperative and long-term out...