Lifespan Cardiovascular Institute

SILVER-AMI Study Physician

Principal Investigator: Barry Sharaf, MD
Rhode Island Hospital

Risk Stratification in Older Persons with Acute Myocardial Infarction

This study is a minimal risk observational study that uses a prospective cohort design to follow older patients hospitalized for AMI. Participants will be assessed at baseline, prior to AMI hospital discharge through an interview, physical assessment and medical record review. Research and medical records will be transmitted to the Silver‐AMI Coordinating Center for data entry into a central, electronic database system with rigorous protection and quality controls. One follow‐up interview will be conducted approximately 6 months later by the Yale Follow‐up Center.

The overall objective of this study is to develop and validate risk stratification tools for older adults who have recently had an AMI. The intent is to use the knowledge from the data collected in Silver‐AMI to ultimately design interventions to improve the care and outcomes of older patients with AMI.

Inclusion Criteria

1. Age ≥75 years upon admission to the hospital
2. Elevation of cardiac markers within 24 hours of presentation to the hospital a. Troponin must rise above the upper limit of normal established by the hospital as a determinate of cardiac injury
3. Any one of the following:
  a.  Symptoms of ischemia– pain in chest, epigastrium, jaw, or arm, lasting 20 minutes or longer - may be accompanied by dyspnea, diaphoresis, nausea, or syncope.
  b.  ECG with ischemic changes:
       i.     ST elevation
       ii.     ST depression
       iii.     T wave inversion in the absence of Left Ventricular Hypertrophy (LVH)
       iv.     New left bundle branch block (LBBB)
       v.     Pathological Q waves
  c.  Imaging evidence of Infarction (e.g. new loss of viable myocardium on nuclear imaging,  new wall motion abnormality on echo, delayed gadolinium enhancement on MRI)
  d. Intracoronary thrombus on angiography

Exclusion Criteria

1. Patient transferred from another hospital with a length of stay >24 hours at the referring hospital. 
2. Refused Informed Consent
3. Decisional impairment with no legally authorized representative
4. AMI is secondary to chest trauma
5. AMI is secondary to inpatient procedure or surgery
6. History of heart transplant
7. Non-English speaking
8. Inability to complete interview (e.g. comatose or aphasia)
9. Inability to contact for follow-up (e.g. no access to phone, not living in the country)
10. Currently a prisoner
11. Death prior to enrollment
12. Previously enrolled in Silver AMI

For more information about this study, contact the Cardiac Projects Office at 401-444-5324.