Effect of Evolocumab on Grafts Post-Coronary Artery Bypass Surgery: Post-Hoc Analysis of Newton-CABG CardioLink-5
Authors' conclusion
Evolocumab did not improve early graft failure, but exploratory results suggest that it may diminish moderate stenoses in SVGs and stenoses with unfavorable features. SVGs accumulated more plaque burden than IMA grafts but with less percentage LAP, possibly due to the early arterialization process involving smooth muscle cell proliferation, neointimal hyperplasia, and extracellular matrix expansion affecting only the SVGs.
Study context
- Population
- Saphenous vein grafts (SVGs), internal mammary artery (IMA) and radial artery grafts after coronary artery bypass surgerygrafts studied · SVGs 1,275 · IMA grafts 514 · radial artery grafts 39
- Comparison
- Evolocumab vs the other treatment group
Methodological detailscoronary computed tomography angiography (CCTA), evaluable grafts 24 months postsurgery
- Coronary computed tomography angiography (CCTA)
- Evaluable grafts 24 months postsurgery
Primary result
As reported in the abstract
Graft failure (stenosis 50% to 100%) · 24 months postsurgery
- No differences between treatment groups for graft failure in any graft type
Further findings
| Outcome | Values | P value |
|---|---|---|
| Moderate lesions (20% to <50%) among SVGs · 24 months postsurgery · lower with evolocumab | Evolocumab 11.5% · Comparator 19.3% | P < 0.001 |
| Moderate lesions in IMA grafts · 24 months postsurgery · similar nonsignificant trend | Evolocumab 3.5% · Comparator 5.9% | |
| Plaque composition, SVGs vs IMA grafts — SVGs vs IMA grafts · greater percentage calcified plaque in SVGs | P < 0.002 | |
| Plaque composition, SVGs vs IMA grafts — SVGs vs IMA grafts · greater percentage mixed plaque in SVGs | P < 0.001 | |
| Plaque composition, SVGs vs IMA grafts — SVGs vs IMA grafts · less percentage LAP in SVGs | P < 0.001 |
Focal stenoses ≥20% with positive remodeling, >25% low-attenuation plaque (LAP), or spotty calcification
- Fewer with evolocumab
Plaque composition, SVGs vs IMA grafts
- SVGs accumulated more plaque burden than IMA grafts
Original publication
Effect of Evolocumab on Grafts Post-Coronary Artery Bypass Surgery: Post-Hoc Analysis of Newton-CABG CardioLink-5. JACC Adv. Published 19 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it