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Re-evaluating Fasting Guidelines for Invasive Cardiac Procedures: A Systematic Review and Meta-analysis of Randomized
Sebhat Erqou1,2,3, Michael Kwok4, Yongdeok Shin1
1Department of Medicine, Mary Washington Hospital, Fredericksburg, Virginia.
Journal of the Society for Cardiovascular Angiography & Interventions
|November 21, 2025
Summary
Fasting before cardiac procedures is standard but not always necessary. Nonfasting is safe, improves patient satisfaction, and may allow for updated guidelines.
Area of Science:
- Cardiology
- Clinical Trials
- Patient Safety
Background:
- Fasting before invasive cardiac procedures is standard practice despite limited evidence.
- Lack of sufficient randomized data has perpetuated this standard of care.
Purpose of the Study:
- To synthesize data from randomized clinical trials (RCTs) comparing fasting versus nonfasting protocols.
- To evaluate the safety and efficacy of nonfasting in patients undergoing cardiac procedures.
Main Methods:
- Systematic literature search for RCTs comparing fasting vs. nonfasting prior to cardiac procedures.
- Meta-analysis of pooled data using a random-effects model.
- Reported standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs).
Main Results:
- Eight RCTs with 3451 participants were analyzed.
- Nonfasting was associated with improved patient satisfaction (SMD 0.78).
- Fasting increased risks of hypotension (OR 1.6) and hunger (OR 2.7), while a trend towards reduced contrast-induced nephropathy did not reach statistical significance.
Conclusions:
- Nonfasting protocols for cardiac procedures are safe and enhance patient satisfaction.
- This evidence supports reconsidering and updating current fasting guidelines for lower-risk invasive cardiac procedures.
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