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Effect of Evolocumab on Grafts Post-Coronary Artery Bypass Surgery: Post-Hoc Analysis of Newton-CABG CardioLink-5

G B John Mancini1, Craig Kamimura1, Michael Szarek2

  • 1Cardiovascular Imaging Core Laboratory, Centre for Cardiovascular Innovation, Dilawri Cardiovascular Institute, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

JACC. Advances
|August 19, 2026
PubMed

Insights

Evolocumab did not prevent early graft failure after coronary artery bypass grafting. However, it showed potential in reducing moderate stenoses and unfavorable plaque features in saphenous vein grafts.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Pharmacology

Background:

  • Graft failure is a significant clinical challenge in coronary artery bypass grafting (CABG).
  • Saphenous vein grafts (SVGs), internal mammary artery (IMA), and radial artery grafts are commonly used conduits.

Purpose of the Study:

  • To evaluate the effect of evolocumab on graft failure, stenosis severity, stenosis types, and plaque burden.
  • Assess outcomes in SVGs, IMA, and radial artery grafts using coronary computed tomography angiography (CCTA).

Main Methods:

  • Analysis of the randomized NEWTON-CABG CardioLink-5 trial data at 24 months post-surgery.
  • Graft stenosis graded as normal (<20%), moderate (20% to <50%), or graft failure (50% to 100%).
  • Stenoses ≥20% classified by positive remodeling, low-attenuation plaque (LAP), or spotty calcification; plaque burden measured.

Main Results:

  • No significant difference in graft failure rates between treatment groups across all graft types.
  • Evolocumab showed a reduction in moderate lesions in SVGs (11.5% vs 19.3%) and a similar trend in IMA grafts.
  • Fewer focal stenoses ≥20% with unfavorable features (positive remodeling, LAP, spotty calcification) were observed with evolocumab.
  • SVGs accumulated more plaque burden than IMA grafts, but with a higher percentage of calcified and mixed plaque and less LAP.

Conclusions:

  • Evolocumab did not improve early graft failure rates in CABG.
  • Exploratory findings suggest evolocumab may reduce moderate stenoses and unfavorable plaque characteristics in SVGs.
  • Differences in plaque accumulation and composition between SVGs and IMA grafts may relate to early arterialization processes.
Abstract

Keywords:
evolocumabgraft failureinternal mammary artery graftlow attenuation plaqueradial artery graftsaphenous vein graft

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