Fasting versus No Fasting Before Percutaneous Cardiovascular Procedures

While the American Society of Anesthesiologists guidelines were updated in 2017 to allow for the intake of clear liquids up to two hours and light meals up to six hours before elective procedures, specific evidence for percutaneous cardiovascular procedures remains limited. This meta-analysis of randomized clinical trials (RCTs) compared the safety and patient satisfaction between fasting and non-fasting strategies prior to these procedures.

The primary aim was to assess the incidence of intraprocedural adverse events, including aspiration pneumonia, nausea or vomiting, hypoglycemia, and contrast-induced nephropathy. As a secondary objective, researchers compared patient satisfaction levels between the two groups.

The analysis included eight studies (six full articles and two abstracts) selected from 650 identified reports. Six trials evaluated patients undergoing cardiac catheterization (coronary angiography or coronary angioplasty), while two addressed transcatheter aortic valve replacement, arrhythmia ablation, or electronic device implantation. A total of 3131 patients were analyzed: 1555 were assigned to the non-fasting group and 1576 to the fasting group. The mean age was 68.0 years, and 67.9% of subjects were men. The average fasting time was 3.11 hours (range: 2.4–5.2 hours) in the non-fasting group and 11.9 hours (range: 7–16.2 hours) in the fasting group.

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Results showed no significant differences in intraprocedural adverse events between the groups (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.59–1.01; p = 0.051; I² = 0%; 7 RCTs). There were no differences regarding aspiration pneumonia (OR: 1.38; 95% CI: 0.36–5.24; I² = 0%), nausea or vomiting (OR: 1.16; 95% CI: 0.67–2.02; I² = 0%), hypoglycemia (OR: 0.78; 95% CI: 0.45–1.35; I² = 0%), or contrast-induced nephropathy (OR: 1.91; 95% CI: 0.93–3.92; I² = 0%). However, the non-fasting group expressed greater satisfaction (mean difference: –1.11; 95% CI: –1.81 to –0.40; I² = 98%).

There were no differences identified between procedure types in the subgroup analyses for adverse events, aspiration pneumonia, nausea, or satisfaction. It should be noted that the use of anesthesia during the procedures was not considered as a factor analyzed or discussed in the results.

Conclusion

In conclusion, based on the available data, not fasting prior to percutaneous cardiovascular procedures represents a safe and reasonable option for most patients, although it should be considered with caution for those at higher risk of nausea, vomiting, or aspiration.

Original Title: Fasting vs No Fasting Prior to Percutaneous Cardiovascular Procedures.

Reference: M. Haisum Maqsood, Jacqueline E. Tamis-Holland, Mamas A. Mamas, Davide Capodanno, Deepak L. Bhatt, Sripal Bangalore. JACC: Cardiovascular Interventions, Volumen 18, pp. 682–684, 2025.