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Turkish Society of Cardiology
Young Cardiologists
President
Dr. Muzaffer Değertekin
Coordinator for the
Board of Directors
Dr. Ertuğrul Okuyan
Coordinator for the
Board of Directors
Dr. Can Yücel Karabay
Members
Dr. Adem Aktan
Dr. Gülşah Aktüre
Dr. Bayram Arslan
Dr. İnanç Artaç
Dr. Ahmet Oğuz Aslan
Dr. Görkem Ayhan
Dr. Ahmet Anıl Başkurt
Dr. Özkan Bekler
Dr. Oğuzhan Birdal
Dr. Yusuf Bozkurt Şahin
Dr. Serkan Bulgurluoğlu
Dr. Ümit Bulut
Dr. Veysi Can
Dr. Mustafa Candemir
Dr. Murat Çap
Dr. Göksel Çinier
Dr. Ali Çoner
Dr. Yusuf Demir
Dr. Ömer Furkan Demir
Dr. Murat Demirci
Dr. Ayşe İrem Demirtola Mammadli
Dr. Süleyman Çağan Efe
Dr. Mehmet Akif Erdöl
Dr. Kubilay Erselcan
Dr. Kerim Esenboğa
Dr. Duygu Genç
Dr. Kemal Göçer
Dr. Elif Güçlü
Dr. Arda Güler
Dr. Duygu İnan
Dr. Hasan Burak İşleyen
Dr. Muzaffer Kahyaoğlu
Dr. Sedat Kalkan
Dr. Yücel Kanal
Dr. Özkan Karaca
Dr. Ahmet Karaduman
Dr. Mustafa Karanfil
Dr. Ayhan Kol
Dr. Fatma Köksal
Dr. Mevlüt Serdar Kuyumcu
Dr. Yunus Emre Özbebek
Dr. Ahmet Özderya
Dr. Yasin Özen
Dr. Ayşenur Özkaya İbiş
Dr. Çağlar Özmen
Dr. Selvi Öztaş
Dr. Hasan Sarı
Dr. Serkan Sivri
Dr. Ali Uğur Soysal
Dr. Hüseyin Tezcan
Dr. Nazlı Turan
Dr. Berat Uğuz
Dr. Örsan Deniz Urgun
Dr. İdris Yakut
Dr. Mustafa Yenerçağ
Dr. Mehmet Fatih Yılmaz
Dr. Yakup Yiğit
Dr. Mehmet Murat Yiğitbaşı
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Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trialTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial (Dr. Şeyma Zeynep Atıcı)Study title: Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial
Presented at: ESC Congress 2025
Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01633-2/abstract?rss=yes
Prepared by: Dr. Şeyma Zeynep Atıcı
Introduction
Saphenous vein graft (SVG) failure is a significant issue following coronary artery bypass grafting (CABG). Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor for atherosclerosis; however, its role in SVG failure remains unclear. This study evaluates the impact of early initiation of intensive LDL-C-lowering therapy with evolocumab on SVG failure.
Objective
NEWTON-CABG is the first randomized, placebo-controlled trial to assess the effect of early initiation of a PCSK9 inhibitor on SVG failure after CABG, in patients under medium-high intensity statin therapy.
Methods
NEWTON-CABG was a multicenter, double-blind, randomized, placebo-controlled trial conducted across 23 centers. Eligible participants were adults who had undergone CABG with at least two SVGs and were on medium or high-intensity statin therapy.
Participants were randomly assigned, within 21 days post-CABG, to receive 140 mg subcutaneous evolocumab or placebo every two weeks.
The primary endpoint was the 24-month vein graft failure rate (VGFR) in the intention-to-treat population.
Results
Evolocumab led to an adjusted mean reduction of 48.4% in LDL-C at 24 months compared to placebo. The 24-month VGFR was 21.7% (149 out of 686 grafts) in the evolocumab group and 19.7% (127 out of 644 grafts) in the placebo group (difference 2.0% [95% CI -3.1 to 7.1]; p=0.44).
Conclusion
Despite a significant reduction in LDL-C, evolocumab did not reduce SVG failure at 24 months post-surgery. The additional reduction in LDL-C did not significantly affect the pathophysiological mechanisms responsible for early SVG failure.
Discussion
While PCSK9 inhibitors continue to play a crucial role in secondary prevention, this study suggests that aggressive LDL-C reduction does not significantly impact the pathophysiological mechanisms of early graft failure. Instead, remodeling, thrombotic, and/or inflammatory processes may be responsible, highlighting the need for further research to develop new strategies for reducing current SVG failure rates.
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