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We compared the 5-year graft occlusion rates and midterm clinical outcomes of saphenous vein composite grafts with those of right internal thoracic artery composite grafts in patients who were enrolled in the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite Graft trial.Of 224 eligible patients with multivessel coronary artery disease who were randomized to undergo off-pump revascularization using the saphenous vein (saphenous vein group, n = 112) or right internal thoracic artery (right internal thoracic artery group, n = 112) as Y-composite grafts based on the in situ left internal thoracic artery from September 2008 to October 2011, 219 patients (saphenous vein group, n = 109; right internal thoracic artery group, n = 110) entered the analysis. A third limb conduit to lengthen the graft limb for complete revascularization was used in 47 patients (saphenous vein group vs right internal thoracic artery group, 8 vs 39). Postoperative 5-year (61.7 ± 5.2 months) angiograms were performed in 186 patients (84.9%; saphenous vein group = 95; right internal thoracic artery group = 91). Follow-up was complete in 97.7% (214/219) of patients with a median follow-up of 80.7 months.The overall graft occlusion rate was 3.6% at 5 years (3.5% in the saphenous vein group vs 3.7% in the right internal thoracic artery group, P = .910). The 5-year occlusion rate of the second limb conduits in the saphenous vein group was 4.3% and was noninferior to that of the right internal thoracic artery group (2.4%) within the 95% 2-sided confidence interval of −1.4% to 5.2% (P < .001 for noninferiority). No statistically significant differences were found in the overall survival (P = .439) and the freedom from major adverse cardiac and cerebrovascular event rates (P = .354) at 5 and 8 years between the 2 groups.The saphenous vein composite grafts were noninferior to the right internal thoracic artery composite grafts in terms of 5-year graft occlusion rates and midterm clinical outcomes.