This post hoc analysis of NEWTON-CABG CardioLink-5 assessed the effects on of evolocumab on 1,275 saphenous vein grafts (SVGs), 514 internal mammary artery grafts, and 39 radial artery grafts by using coronary computed tomography angiography CCTA at 24 months. As previously reported, evolocumab did not reduce graft failure in any graft type.
However, in SVGs, moderate stenoses were lower with evolocumab (11.5 percent vs 19.3 percent; p<0.001), with fewer focal lesions showing positive remodeling, >25 percent low attenuation plaque, or spotty calcification. SVGs accumulated more plaque than internal mammary artery grafts, but with more calcified and mixed plaque and less low-attenuation plaque.
The authors conclude that while evolocumab did not improve early graft failure, it may reduce moderate and unfavorable SVG lesions over the long term. Unfortunately, the follow-up needed to observe these potential effects is reported by the authors to not be continued due to multiple constraints.
