Baylor University Medical Center Proceedings April 2017 - 162

AS in patients with AMI is not a risk factor for LV free wall
rupture and/or aneurysm formation (2, 3). When AMI occurs
in patients with signiﬁcant AS, however, the LV systolic pressure
remains elevated and the continuation of this elevation appears
to increase the likelihood of LV rupture and/or aneurysmal formation, particularly when the AMI involves the LV apical wall,
which normally is several times thinner than the LV basal wall.
There is some data on the frequency of AS in older populations and on the frequency of AMI and sudden cardiac death
among patients with AS. In an autopsy study, Roberts and
Shirani (7) found severe AS to be present in 43 (11%) of 391
patients aged 80 to 89 years, in 8 (9%) of 93 patients aged 90
to 99 years, and in 0 of 6 patients aged ≥100 years, or in 51
(10%) of the total 490 patients aged 80 years or over. Of the
490 autopsied patients, 229 (47%) had acute and/or healed
myocardial infarcts. Aronow and colleagues (8) studied by echocardiogram 1797 older patients (mean age 82 years) and found
AS in 301 (17%)-severe in 40, moderate in 96, and mild in
165. Among their 301 patients with AS, 158 (52%) had had
an earlier AMI that healed, and 217 (72%) had a new AMI or
died suddenly. There was no mention of LV free wall rupture or
LV aneurysm. There have been at least 2 case reports of AMI in
patients with AS and normal epicardial coronary arteries (9, 10).
Neither had LV free wall rupture or aneurysm.
The major limitation of this minireview is that the number
of patients with AMI associated with AS without LV free wall
rupture or LV aneurysm is entirely unknown. Conversely,
the reported cases of LV free wall rupture and/or aneurysm
complicating AMI in patients with AS may represent, of course,
the tip of the iceberg.

162

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Baylor University Medical Center Proceedings

Volume 30, Number 2

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