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Objective: To better characterize intrastent pathology using optical coherence tomography (OCT) in patients presenting with late and very late stent thrombosis (LST/VLST).Background: The contribution of specific intrastent pathologies to the development of LST/VLST is not well understood.Methods: In this single-center, retrospective, observational study of 796 consecutive patients treated for ST-segment elevation myocardial infarction (STEMI) with primary PCI we identified 57 patients (7.2%) in whom STEMI resulted from LST/VLST. Of the patients with LST/VLST, 21 patients (37%) had OCT performed at the discretion of the operator during PCI for LST/VLST. Independent reviewers performed qualitative offline analysis of OCT images to determine the cause of stent thrombosis defined as the specific intrastent pathology associated with thrombus deposition.Results: The principal intrastent pathology causing LST/VLST was determined to be stent malapposition in 11 patients (55%), of which 5 (25% of all LST/VLST patents) had findings suggestive of positive vessel remodeling. Neoatherosclerosis was determined to be the cause of LST/VLST in 7 patients (35%). LST/VLST resulted from uncovered stent struts in 2 patients (10%). Among all LST/VLST patients, in-hospital mortality (12.3%) and post-hospital target vessel failure (TVF) or cardiac death (21.7%, median follow-up 1.6 years) remained high. There was a trend towards decreased TVF or cardiac death (7.7% vs. 27.3% P = 0.24) in patients who underwent OCT-guided therapy.Conclusions: LST/VLST remains a significant cause of STEMI and is associated with considerable morbidity and mortality. OCT use at the time of PCI consistently identifies significant intrastent pathology with potentially meaningful clinical impact. [ABSTRACT FROM AUTHOR]

Adult T‐cell leukemia‐lymphoma (ATL) is a peripheral T‐cell lymphoma caused by human T‐cell lymphotropic virus type I. Previous retrospective studies suggested the presence of graft‐vs‐ATL (GV‐ATL) effects associated with acute graft‐vs‐host disease (GVHD), which suggests that intentional induction of acute GVHD to facilitate the efficacy of GV‐ATL effects might reduce the risk of relapse and contribute to improved survival after allogeneic hematopoietic stem cell transplantation. However, it is impractical to conduct a prospective study to assess the benefit of intentional induction of acute GVHD. In a simulation analysis using a Markov model, we assessed the impact on overall survival (OS) of changing the probability of overall acute GVHD and severe acute GVHD. When the probability of grade III‐IV acute GVHD changed from 0% to 100%, the expected 2‐year OS rate changed from 57.0% to 21.8% (48.2% of baseline at 2 years). When the probability of all grades of acute GVHD changed from 0% to 100%, the expected 2‐year OS rate changed from 48.2% to 49.5%. In conclusion, increasing the probability of overall acute GVHD was beneficial only when the proportion of grade III‐IV acute GVHD was lower than that in the original data. Based on the simulation results, preventive management of grade III‐IV acute GVHD is mandatory to achieve the clinical benefit associated with grade I‐II GVHD. [ABSTRACT FROM AUTHOR]