Effect of Evolocumab on Saphenous Vein Graft Patency Following Coronary Artery Bypass Surgery

Inclusion Criteria - To be considered eligible for participation in this study, aparticipant must satisfy each of the following criteria:

1. Age ≥ 18 years

2. Scheduled to undergo coronary artery bypass graft (CABG) surgery (with or withoutcardiopulmonary bypass (CPB); with or without single valve repair/replacement)

3. CABG procedure included/planned to include at least two saphenous vein grafts

4. CABG procedure occurred within the past 21 days, or is planned within the next 60 days

5. On a moderate to high intensity statin therapy (defined as atorvastatin 40-80mg daily,rosuvastatin 20-40mg or simvastatin 40mg daily) unless a lower dose, or another statinor non-statin therapy is clinically justified Exclusion Criteria - A participant will be ineligible for participation in this study if heor she satisfies any one or more of the following criteria:

6. Patients in whom additional lowering of LDL-C with evolocumab is deemed to beclinically inappropriate

7. Allergy to contrast dye

8. Known severe hepatic impairment (Childs-Pugh, Class C).

9. Known renal disease with estimated glomerular filtration rate (eGFR) < 30mL/min/1.73m2

10. Recipient of any major organ transplant (eg, lung, liver, heart, bone marrow)

11. Use of cholesterylester transfer protein (CETP) inhibition treatment within 12 monthsprior to randomization.

12. Current, prior within past year, or known planned use of PCSK9 inhibition treatment

13. Severe cardiovascular or concomitant non-cardiovascular disease that is expected toreduce life expectancy to less than 2 years

14. Major active infection, or major hematologic, renal, respiratory, metabolic,gastrointestinal or endocrine dysfunction

15. Women who are pregnant or breastfeeding

16. Women of child bearing potential who are unwilling to use proper family planning orbirth control methods to avoid pregnancy. Women are considered post-menopausal and notof childbearing potential after 12 months of natural (spontaneous) amenorrhea or havehad a surgical procedure such as hysterectomy which makes pregnancy impossible.

17. Known intolerance or allergy to evolocumab or other PCSK9 inhibitors.

18. Currently taking simvastatin >40mg/day, niacin or bile acid sequestrants

19. Known latex allergy

20. Inability to comply with protocol-required study visits or procedures, includingadministration of study drug

21. Known history of cancer within the past 5 years (except for carcinoma in-situ of thecervix, stage 1 prostate cancer or adequately treated non-melanoma carcinomas of theskin)

22. Participation in another investigational device or drug study which is likely toaffect the primary outcome, within 30 days of planned initiation of study drug

23. NYHA class IV

24. Pacemaker or other implantable device implanted within 30 days prior to screening

Additional postoperative exclusion criteria:

1. Received only <2 vein grafts

2. Major peri-operative complications following CABG surgery (e.g. stroke, MI, renalfailure requiring dialysis, or postoperative ICU stay > 5 days) prior to randomization