Peter G Mills

NIHR Oxford Biomedical Research, Oxford, England, United Kingdom

Are you Peter G Mills?

Claim your profile

Publications (44)311.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The relation between socio-economic status (SES) and outcomes after percutaneous coronary intervention (PCI) has not been established. We sought to determine whether or not socio-economic status impacts on prognosis after PCI. This was an observational cohort study of 13,770 consecutive patients who underwent PCI at a single centre between 2005 and 2011. Patient socio-economic status was defined by the English Index of Multiple Deprivation (IMD) score, according to residential postcode. Patients were analysed by quintile of IMD score (Q1, least deprived; Q5, most deprived). Median follow-up was 3.7 (IQR: 2.0-5.1) years and the primary outcome was all-cause mortality. Patients in Q5 (most deprived) were younger, more commonly South Asian, and had higher rates of smoking, diabetes mellitus, renal impairment, previous MI, and previous PCI than patients in Q1. Rates of long-term mortality increased progressively across the five quintiles of IMD score in a linear fashion (p=0.0004), as did rates of recurrent MI, target vessel revascularisation, and CABG. The difference in mortality rates persisted after adjustment for other potential confounding factors after multivariate analysis (Q5 vs. Q1: HR 1.93, 95% CI: 1.38-2.69). In this large contemporary cohort of patients receiving PCI, socio-economic status was associated with prognosis in a linear fashion.
    No preview · Article · Feb 2015 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: This study presents an interim safety and feasibility analysis of the REGENERATE-IHD randomized controlled trial, which is examining the safety and efficacy of three different delivery routes of bone marrow-derived stem cells (BMSCs) in patients with ischemic heart failure. Methods & results: The first 58 patients recruited to the REGENERATE-IHD study are included in this interim analysis (pilot). Symptomatic patients with ischemic heart failure were randomized to receive subcutaneous granulocyte colony-stimulating factor or saline injections only; or subcutaneous granulocyte colony-stimulating factor injections followed by intracoronary or intramyocardial injections of BMSCs or serum (control). No significant differences were found in terms of safety and feasibility between the different delivery routes, with no significant difference in procedural complications or major adverse cardiac events. There was a signal towards improved heart failure symptoms in the patients treated with intramyocardial injection of mobilized BMSCs. Conclusion: Peripheral mobilization of BMSCs with or without subsequent direct myocardial delivery appears safe and feasible in patients with chronic ischemic heart failure.
    No preview · Article · May 2014 · Regenerative Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity worldwide despite the latest therapeutic advances designed to decrease myocardial injury. Preclinical and emerging clinical evidence show that the intracoronary injection of autologous bone marrow mononuclear cells (BMCs) following AMI leads to improvement in left ventricular ejection function (LVEF). In this clinical trial we will for the first time assess the effect of early (<24 h) infusion of autologous BMCs following AMI on cardiac function. REGENERATE-AMI is a double-blind, randomised, multicentre, placebo-controlled trial to determine whether early (<24 h) intracoronary infusion of BMCs improves LVEF after AMI. The study will enrol 100 patients presenting with an anterior AMI demonstrating anterior regional wall motion abnormality. Patients will be randomised to receive intracoronary infusion of BMCs or placebo (0.9% saline). Primary endpoint will be change in LVEF at 1 year compared to baseline, measured by cardiac MRI. Secondary endpoints at 6 months include the change in global LVEF relative to baseline measured by quantitative left ventriculography and echocardiography, as well as major adverse cardiac events which is also measured at 1 year. The study will be performed in agreement with the Declaration of Helsinki and is approved by local ethics committee (NRES Committee London West London: 07/Q0603/76). http://clincialtrials.gov (NCT00765453). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals.
    Full-text · Article · Jan 2014 · BMJ Open
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Apical hypertrophic cardiomyopathy (HCM) is commonly associated with drug-refractory chest pain. We sought to determine whether, in apical HCM, coronary perfusion time is abbreviated by the diastolic persistence of apical contraction, resulting in impaired myocardial perfusion and chest pain. Methods: 62 apical HCM patients had cardiac magnetic resonance (CMR) scans assessed for stress perfusion (myocardial perfusion reserve index (MPRi)), late gadolinium enhancement (LGE; % of myocardial volume) left ventricular (LV) volumes and LV contractile persistence (% total cardiac cycle) at the LV apex and base. Radial and circumferential strain were assessed. Patients were divided into three groups on the basis of severity of contractile persistence. The interval between earliest and latest systolic peaks was measured from strain data from each of the apical segments. Results: Compared to subjects with the least contractile persistence (C1), those with the most (C3) were more likely to have chest pain (94% vs 63%, p<0.05) and lower MPRi (0.90±0.24 vs 1.43±0.50, p<0.05). Multiple regression analyses included contractile persistence, LVH, %LGE, age and gender. Contractile persistence was independently associated with chest pain (0.4 per 10% cardiac cycle, CI 95%; 0.1 to 0.8, p<0.05) and a reduction in apical MPRi (-0.09 per 10% cardiac cycle, CI 95%; -0.04 to -0.15, p<0.01). There were striking differences in systolic strain between C1 and C3. First, radial strain was almost absent in C3, with only post-systolic contraction detected. Second, temporal dispersion in circumferential strain was greater in C3 than C1 (230±101ms vs 114±44ms, p<0.05). Using the convention >130ms as a threshold, circumferential dyssynchrony was present in 25% of C1 and 81% of C3 patients (p<0.001) and radial dyssynchrony in 65% of C1 and 95% of C3 patients (p<0.05). In patients with radial dyssynchrony, the earliest peak was most often in the inferior or anterior segments (60%) and the latest in the lateral segment (33%). In patients with circumferential dyssynchrony, the earliest peak was most often in the inferior or anterior segments (59%) and the latest in the lateral segment (41%). Conclusion: In apical HCM, regional persistence of contractility into diastole causes myocardial ischaemia and chest pain. This is the first description of contractile persistence and dyssynchrony as a mechanism for myocardial perfusion abnormalities and presents novel therapeutic opportunities for drug-refractory chest pain in apical HCM.
    Preview · Article · Aug 2013 · European Heart Journal
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The incidence of infective endocarditis (IE) in dialysis patients is higher than the general population. Dialysis patients who develop endocarditis are thought to have a poorer prognosis than other patients with IE. Aim: To examine the risk profiles, clinical features, and outcomes of patients on dialysis who developed IE in a large cohort. Design and Methods: A retrospective analysis of all patients developing IE on dialysis (using the modified Duke criteria) was undertaken between 1998 and 2011. Patients were identified from a prospectively collected clinical database. Results: 42 patients developed IE out of a total incident dialysis population of 1,500 over 13 years. 95% of the patients (40/42) were on long-term haemodialysis (HD) and 5% (2/42) on peritoneal dialysis. Mean patient age was 55.2 years (IQR: 43-69), and mean duration of HD prior to IE was 57.4 months. Primary HD access at the time of diagnosis was an arteriovenous fistula in 35% (14/40), a dual-lumen tunnelled catheter in 55% (22/40), and a dual-lumen non-tunnelled catheter in 10% (4/40). Staphylococcus aureus (including methicillin-resistant S. aureus) was present in 57.1% (24/42). The aortic valve was affected in 42.8% of the patients (18/42), the mitral valve in 30.9% (13/42), and both valves in 9.5% (4/42). 33.3% of the patients had an abnormal valve before the episode of IE. In 21.4% (9/42), valve surgery was performed and mortality was lower in the surgical group compared to the group managed medically during hospitalisation (11.1 vs. 15.2%, p = 0.892), at 3 months (13.1 vs. 19.6%, p = 0.501), and during follow-up (p = 0.207), but this difference did not reach statistical significance. Age >60 years, septic emboli, and methicillin-resistant S. aureus were all adverse prognostic factors. Patients receiving surgery were younger (mean 47.1 ± 14.4 years vs. 57.4 ± 14.3, p = 0.049) and less likely to be infected with S. aureus (surgery 33.3% vs. antibiotics 63.6%, p = 0.046). Conclusion: This is one of the largest reported series of IE in dialysis patients. The incidence of IE remains high and the prognosis poor in dialysis patients, although patients selected for early valve surgery have good 1-year survival.
    No preview · Article · Jul 2013 · Nephron Clinical Practice

  • No preview · Article · May 2013 · Heart (British Cardiac Society)
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: AimsMyocardial revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) carries the risk of serious complications. Observational data suggest that outcomes may be improved by experienced operators, but there are few studies that have analysed the relationship between mortality and primary operator grade. The aim of this study was to investigate the effect of operator grade (trainee vs. consultant) upon outcomes of revascularization procedures.Methods and resultsThis was an observational study at a tertiary cardiology centre with accredited training programmes, between 2003 and 2011. A total of 22 697 consecutive patients undergoing either CABG or PCI were included. Associations between operator grade and mortality were assessed by hazard ratios, estimated by Cox regression analyses; 6689 patients underwent CABG, whereas 16 008 underwent PCI. Trainees performed 1968 (29.4%) CABG procedures and 8502 (53.1%) PCI procedures. The proportion of procedures performed by trainees declined over time for both CABG (30.2% in 2003 vs. 26.0% in 2010) and for PCI (58.1% in 2003 vs. 44.5% in 2010). In the unadjusted Cox analysis, consultant operator grade was associated with an increased 5-year mortality after both CABG [HR: 1.26 (95% CI: 1.07-1.47)] and PCI procedures [HR: 1.34 (95% CI: 1.22-1.47)] compared with a trainee operator. However, following multiple adjustment, consultant grade was no longer associated with mortality after either procedure [CABG: HR: 1.02 (95% CI: 0.87-1.20), PCI: HR: 1.08 (95% CI: 0.98-1.20)].Conclusion There was no observed detrimental effect on patient outcomes arising from procedures undertaken by trainees working in a structured training environment compared with consultants. Published on behalf of the European Society of Cardiology. All rights reserved.
    Full-text · Article · May 2013 · European Heart Journal
  • Source

    Preview · Article · Oct 2012 · Journal of the American College of Cardiology
  • Source

    Full-text · Article · Oct 2012 · Journal of the American College of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Constrictive pericarditis (CP) is a recognised, but unusual cause of chronic ascites.1 ,2 Patients with pericardial constriction may present to non-cardiological specialties,3 ,4 with the symptoms and signs leading to the diagnosis of congestive cardiac failure, lung disease or liver disease.5 ,6 It is important to suspect and rule out CP because with surgery it is treatable and potentially curable. Much of the difficulty in diagnosing CP can be attributed to its insidious course and the absence of typical cardiopulmonary symptoms. Over 50% of patients ending up with pericardiectomy lack symptoms of dyspnoea and orthopnoea.7 We present two cases, which highlight the potential difficulties in diagnosing CP in patients with chronic ascites. We review the key steps in diagnosis and management, emphasising that raised jugular venous pressure (JVP) is one of the crucial observations in making the diagnosis.
    No preview · Article · Sep 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare short and medium-term prognosis in South Asian and Caucasian patients undergoing percutaneous coronary intervention (PCI) to determine if there are ethnic differences in case death rates. Retrospective cohort study. A cardiology referral centre in east London. 9771 patients who underwent PCI from October 2003 to December 2007 of whom 7966 (81.5%) were Caucasian and 1805 (18.5%) were South Asian. In-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target vessel revascularisation), subsequent revascularisation rates (PCI and coronary artery bypass grafting; CABG) and all-cause mortality during a median follow-up of 2.5 years (range 1.5-3.6 years). South Asian patients were younger than Caucasian patients (59.69±0.27 vs 64.69±0.13 years, p<0.0001), and more burdened by cardiovascular risk factors, particularly type II diabetes mellitus (45.9%±1.2% vs 15.7%±0.4%, p<0.0001). The in-hospital rates of MACE were similar for South Asians and Caucasians (3.5% vs 2.8%, p=0.40). South Asians had higher rates of clinically driven PCI for restenosis and subsequent CABG, although Kaplan-Meier estimates of all-cause mortality showed no significant differences; this was regardless of whether PCI was performed post-acute coronary syndrome or as an elective procedure. The adjusted hazard of death for South Asians compared with Caucasians was 1.00 (95% CI 0.81 to 1.23). In this large PCI cohort, the in-hospital and longer-term mortality of South Asians appeared no worse than that of Caucasians. South Asians had higher rates of restenosis and CABG during follow-up. Data suggest that the excess coronary mortality for South Asians compared with Caucasians is not explained by differences in case-fatality rates.
    No preview · Article · Nov 2011 · Heart (British Cardiac Society)
  • [Show abstract] [Hide abstract]
    ABSTRACT: In patients presenting with acute cardiac symptoms, abnormal ECG and raised troponin, myocarditis may be suspected after normal angiography. To analyse cardiac magnetic resonance (CMR) findings in patients with a provisional diagnosis of acute coronary syndrome (ACS) in whom acute myocarditis was subsequently considered more likely. 79 patients referred for CMR following an admission with presumed ACS and raised serum troponin in whom no culprit lesion was detected were studied. 13% had unrecognised myocardial infarction and 6% takotsubo cardiomyopathy. The remainder (81%) were diagnosed with myocarditis. Mean age was 45±15 years and 70% were male. Left ventricular ejection fraction (EF) was 58±10%; myocardial oedema was detected in 58%. A myocarditic pattern of late gadolinium enhancement (LGE) was detected in 92%. Abnormalities were detected more frequently in scans performed within 2 weeks of symptom onset: oedema in 81% vs 11% (p<0.0005), and LGE in 100% vs 76% (p<0.005). In 20 patients with both an acute (<2 weeks) and convalescent scan (>3 weeks), oedema decreased from 84% to 39% (p<0.01) and LGE from 5.6 to 3.0 segments (p=0.005). Three patients presented with sustained ventricular tachycardia, another died suddenly 4 days after admission and one resuscitated 7 weeks following presentation. All 5 patients had preserved EF. Our study emphasises the importance of access to CMR for heart attack centres. If myocarditis is suspected, CMR scanning should be performed within 14 days. Myocarditis should not be regarded as benign, even when EF is preserved.
    No preview · Article · Nov 2010 · Heart (British Cardiac Society)
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The incidence of Infective endocarditis (IE) in dialysis patients is higher than the general population. Dialysis patients who develop endocarditis are thought to have a poorer prognosis. We examined the risk factors and outcome of IE in a dialysis cohort. Methods A retrospective analysis of all patients developing IE on dialysis (using the Duke criteria) was undertaken between 1998 and 2008. Patients were identified using a prospectively collected clinical database. Results Thirty patients developed IE out of a total dialysis population of 1500 (incidence 2% year; normal population 0.003–6%). The overall 1-year survival was 50%. Ninety three per cent (28/30) patients were on long-term haemodialysis (HD) and 7% (2/30) on peritoneal dialysis (PD). Mean patient age was 59 years (range: 32–87), and mean duration of HD prior to IE was 34 months. Primary HD access was an arteriovenous fistula in 32% (9/28), a dual-lumen tunnelled catheter in 54% (15/28), and a dual-lumen non-tunnelled catheter in 14% (4/28). Staphylococcus aureus (SA) (including MRSA) was present in 47% (14/30). The aortic valve was affected in 47% (14/30) of patients, mitral valve in 27% (6/30) of patients, and both valves in 10% (3/30). Thirty-six per cent of patients had an abnormal valve before the episode of IE. In 20% (6/30) valve surgery was performed and survival was 83% at discharge and was maintained at 1 year (abstract 095 figure 1). In 80% (24/30) antibiotic therapy alone was employed and survival was 83% (20/24) at discharge, but only 38% (9/24) at 1 year. Age >60, septic emboli and MRSA were all adverse prognostic factors. Patients receiving surgery were younger (mean 56 vs 61) and less likely to be infected with SA (surgery 29% vs antibiotics 70%). Conclusions This is one of the largest reported series of IE in dialysis patients. The incidence of IE remains high and the prognosis poor in dialysis patients, although patients selected for early valve surgery have good 1-year survival.
    Preview · Article · Jun 2010 · Heart (British Cardiac Society)
  • Source

    Full-text · Article · Jan 2010 · Journal of Cardiovascular Magnetic Resonance
  • Source

    Full-text · Article · Jan 2010 · Journal of Cardiovascular Magnetic Resonance
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To discover whether applicants regard structures interviews as a fair method of selection for jobs. Audit study of short-listed candidates for postgraduate specialty training programmes in the London Deanery. Postgraduate applications for the London Deanery. Satisfaction or otherwise with the application and selection process for postgraduate specialty training programmes amongst short-listed candidates in the London Deanery. Questions were asked under five categories: the applicant, the advertisement, the application form, the short-listing process, and the interview. 89 of 118 forms were completed and analysed. Candidates thought the advertisement was clear on who to contact (97%), when short-listed candidates would be notified of their interview (66%) and when interviews would occur (93%). The design of the application form and the short-listing process both scored a median of 1 or 2 (strongly agree or agree) on all points. The interview process itself also scored well, with most candidates scoring broadly positively. As in the previous study, the overall response was broadly a positive one from the candidates' perspective, with the majority of candidates finding the system fair and objective.
    Preview · Article · Jun 2008 · Journal of the Royal Society of Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the reliability and feasibility of assessing the performance of medical specialist registrars (SpRs) using three methods: the mini-clinical evaluation exercise (mini-CEX), directly observed procedural skills (DOPS) and multi-source feedback (MSF) to help inform annual decisions about the outcome of SpR training. We conducted a feasibility study and generalisability analysis based on the application of these assessment methods and the resulting data. A total of 230 SpRs (from 17 specialties) in 58 UK hospitals took part from 2003 to 2004. Main outcome measures included: time taken for each assessment, and variance component analysis of mean scores and derivation of 95% confidence intervals for individual doctors' scores based on the standard error of measurement. Responses to direct questions on questionnaires were analysed, as were the themes emerging from open-comment responses. The methods can provide reliable scores with appropriate sampling. In our sample, all trainees who completed the number of assessments recommended by the Royal Colleges of Physicians had scores that were 95% certain to be better than unsatisfactory. The mean time taken to complete the mini-CEX (including feedback) was 25 minutes. The DOPS required the duration of the procedure being assessed plus an additional third of this time for feedback. The mean time required for each rater to complete his or her MSF form was 6 minutes. This is the first attempt to evaluate the use of comprehensive workplace assessment across the medical specialties in the UK. The methods are feasible to conduct and can make reliable distinctions between doctors' performances. With adaptation, they may be appropriate for assessing the workplace performance of other grades and specialties of doctor. This may be helpful in informing foundation assessment.
    Full-text · Article · May 2008 · Medical Education
  • Source
    Francois Delahaye · Joyce Wong · Peter G Mills

    Full-text · Article · Apr 2007 · Heart (British Cardiac Society)
  • Source
    Andrew Wragg · Peter Mills · Roger Hall
    [Show abstract] [Hide abstract]
    ABSTRACT: A 70 year old man presented with microscopic haematuria and proteinuria and a fever five months after having a transurethral resection of the prostate (TURP). Initially urological review was arranged as the family doctor thought that a urinary infection was the most likely diagnosis. The patient was concerned that he was not getting better and he self-referred to a physician. He had continuing fever, weight loss, and malaise. The physician detected a mitral pan-systolic murmur that had not been heard before. On the basis of this finding infective endocarditis was suspected and investigations begun. His subsequent course and its management are discussed in an interactive case presentation.
    Full-text · Article · Jun 2004 · Heart (British Cardiac Society)
  • Source
    Andrew Wragg · Peter Mills · Roger Hall

    Full-text · Article · Jan 2004

Publication Stats

1k Citations
311.66 Total Impact Points

Institutions

  • 2015
    • NIHR Oxford Biomedical Research
      Oxford, England, United Kingdom
  • 2011-2014
    • Barts Health NHS Trust
      Londinium, England, United Kingdom
  • 1999-2014
    • Liverpool Heart And Chest Hospital
      Liverpool, England, United Kingdom
  • 2012
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2008
    • Royal College of Physicians
      Londinium, England, United Kingdom
  • 2004
    • National Heart, Lung, and Blood Institute
      Maryland, United States
  • 2001
    • University of London
      Londinium, England, United Kingdom
  • 2000
    • University of Wales
      Cardiff, Wales, United Kingdom
  • 1997
    • Royal Cornwall Hospitals NHS Trust
      Truro, England, United Kingdom
  • 1995
    • St. Antonius Ziekenhuis
      Nieuwegen, Utrecht, Netherlands