Fasting vs. no fasting prior to catheterization laboratory procedures: the SCOFF trial

Area of Science:

• Cardiology
• Anesthesiology
• Gastroenterology

Background:

• Current guidelines mandate prolonged fasting (6h solid, 2h liquid) before cardiac procedures with conscious sedation.
• Evidence supporting these fasting recommendations is limited, prompting investigation into alternative strategies.
• Previous single-center studies suggested the safety of omitting fasting requirements.

Purpose of the Study:

• To determine if a no-fasting strategy is non-inferior to traditional fasting prior to cardiac catheterization procedures.
• To evaluate the safety and efficacy of removing fasting restrictions in patients undergoing cardiac procedures with conscious sedation.

Main Methods:

• A multicenter, randomized, open-label, blinded endpoint trial was conducted in Australia.
• 716 patients undergoing coronary angiography, PCI, or CIED procedures were randomized 1:1 to fasting or no-fasting.
• The primary outcome was a composite of aspiration pneumonia, hypotension, hyperglycemia, and hypoglycemia, assessed using Bayesian methods.

Main Results:

• No fasting significantly reduced the primary composite outcome (12.0% vs. 19.1%), demonstrating non-inferiority and superiority.
• Patient satisfaction scores were significantly higher in the no-fasting group (mean difference 4.02 points).
• Secondary outcomes, including adverse events and mortality, were similar between groups.

Conclusions:

• A no-fasting strategy is non-inferior and superior to traditional fasting for patients undergoing cardiac catheterization and CIED procedures.
• Eliminating fasting requirements improves patient satisfaction without compromising safety.
• These findings support revising current guidelines to remove pre-procedure fasting for conscious sedation in cardiac interventions.