In the previous single-center study, we evaluated the evidence for fragments of atherosclerotic plaques, such as foamy macrophages, cholesterol crystals, and thin fibrous cap, in the aspirated thrombi in patients with BMS thrombosis. Fragment of atherosclerosis was observed in 13 out of 42 patients with BMS VLST in the previous study, while it was observed only in 3 out of 24 patients with DES VLST in the current study. Although the time intervals between the index procedure and VLST was significantly shorter in patients with DES VLST as compared with those with BMS VLST, it was surprising that the prevalence of fragment of atherosclerosis was lower in patients with DES VLST as compared with BMS VLST, given the high prevalence of in-stent neoatherosclerosis reported in the DES-treated lesions. Further human pathologic and/or imaging studies are important to investigate the possible role of in-stent neoatherosclerosis as one of the mechanisms of DES VLST. Although it has not been fully clarified whether DAPT beyond 1 year could decrease the incidences of VLST, 12 out of 24 patients underwent DAPT at the time of VLST in this study. From the long-term follow-up of j-Cypher registry, which was a nationwide Japanese registry of patients with SES implantation, 43.9% of patients underwent DAPT at 5 years. Physicians might prolong the duration of DAPT after the observation of abnormal findings at the scheduled follow-up angiography, especially in patients with the first generation DES. Gefitinib health related quality of life is an important dimension of individuals’ well-being. The measurement of HRQoL is particularly relevant in the management of chronic diseases which are known to be associated with impaired HRQoL over extended periods and where the treatment outcomes should include perceptive benefits to patient mental and physical health as well. Diabetes mellitus and hypertension, the two most prevalent disorders worldwide, have been reported to be associated with modest reductions in HRQoL. However, most of the studies linking HRQoL to these diseases have been conducted in individuals with previously diagnosed disease. Also most studies have not evaluated associated comorbidities completely. Therefore, it is not clear whether the reported reductions in the HRQoL in patients with already diagnosed diabetes mellitus and hypertension are due to the disease process itself, comorbid conditions, therapeutic interventions and/or awareness of the disease. The impact of awareness may be particularly pertinent given the widespread implementation of screening programs for diabetes mellitus, hypertension and dyslipidemia. Several studies assessing the impact of awareness of disease on HRQoL in newly screen-diagnosed individuals have yielded inconsistent results. Studies involving screening for diabetes mellitus have found that when diabetes is diagnosed through screening, there is a short term increase in anxiety but not in HRQoL measured in the longer term. The diagnosis of hyperlipidemia was also found to have no negative effect on mental health 25 years after diagnosis. On the contrary, compared with undiagnosed individuals, those with diagnosed hypertension have been found to have poorer HRQoL.