Effect of Evolocumab on Saphenous Vein Graft Patency After Coronary Artery Bypass Surgery (NEWTON-CABG CardioLink-5): An International, Randomized, Double-Blind, Placebo-Controlled Trial

The authors conducted the NEWTON-CABG CardioLink-5 trial to assess whether intensive lowering of low-density lipoprotein cholesterol (LDL-C) lowering with evolocumab reduces saphenous vein graft (SVG) failure after coronary artery bypass grafting (CABG). This multicenter, double-blind, randomized, placebo-controlled study enrolled 782 patients across 23 sites, all of whom received statin therapy and underwent CABG with at least two SVGs. Participants were randomized to receive either evolocumab or placebo within 21 days of surgery and were followed for 24 months. Evolocumab achieved a 48 percent placebo-adjusted reduction in LDL-C levels. However, the 24-month vein graft disease rate did not differ significantly between groups, with rates of 21.7 percent in the evolocumab arm vs 19.7 percent in the placebo group (p=0.44). Adverse events were similar in both groups. The authors conclude that LDL-C lowering with evolocumab does not prevent early SVG failure despite substantial lipid reduction.