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H Higham

Publications and source records attributed to H Higham.

6 recordsLinked to original sources
PubMed2004

Peri-operative troponin I concentration as a marker of long-term postoperative adverse cardiac outcomes--a study in high-risk surgical patients.

We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow-up and case-notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. Increases in troponin I and troponin T concentrations, as well as a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were measured in 12, 13, 33 and 15 patients respectively. Thirty-nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio [95% confidence intervals] = 4.19 [1.16-14.87], 3.97 [1.65-9.44] and 5.19 [1.60-16.22], respectively).

Aged↗
PubMed2001

Peri-operative silent myocardial ischaemia and long-term adverse outcomes in non-cardiac surgical patients.

Two hundred and seventy-five non-cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre- and postoperatively. There were 34 adverse events over the whole study period. Twenty-four occurred within 6 months and the remaining 10 occurred between 6 and 12 months postoperatively. Silent myocardial ischaemia was associated with adverse outcome over both the first 6 months [OR 4.44 (95% CI 1.77-11.13)] and the whole study period [OR 2.81 (1.26-6.07)]. Other risk factors were: vascular surgery [OR 17.09 (2.67-351.44)], history of angina [OR 6.29 (2.21-17.62)], concurrent treatment with calcium entry blockers [OR 2.68 (1.03-6.93)] and smoking [OR 4.93 (2.00-12.02)]. None of these was a useful predictor of long-term outcome (between 6 and 12 months postsurgery). These results are at variance with other published data, but we conclude that monitoring for peri-operative silent myocardial ischaemia does not aid the prediction of long-term cardiovascular complications.

Adult↗