Re-evaluating Fasting Guidelines for Invasive Cardiac Procedures: A Systematic Review and Meta-analysis of Randomized...

Although questioned for more than a decade, fasting prior to invasive cardiac procedures remains the standard of care, due to lack of sufficient randomized data. We sought to synthesize data from existing randomized clinical trials (RCTs) comparing fasting vs nonfasting prior to cardiac procedures.

We performed a systematic literature search for RCTs comparing fasting vs nonfasting prior to invasive cardiac procedures with moderate sedation. Data were pooled using a random-effects model meta-analysis. We report standardized mean differences (SMDs) or odds ratios (ORs) and 95% CIs.

Overall, 8 RCTs comprising of 3451 participants were included. The average fasting time was 845 minutes in the fasting group and 196 minutes in the nonfasting group. The pooled patient satisfaction score across 6 studies was SMD 0.78 (95% CI, 0.25-1.31) favoring the nonfasting arm. Hypotension (4 studies; OR, 1.6; 95% CI, 1.2-2.3) and hunger (3 studies; OR, 2.7; 95% CI, 1.8-3.7) were significantly higher in the fasting arm. There was a trend toward lower risk of contrast-induced nephropathy (OR, 0.7; 95% CI, 0.4-1.0) in the fasting arm across 4 studies with available data, but it did not reach statistical significance (P = .06). There was no difference in post- vs pre- procedure delta creatinine clearance (SMD, 0.07; 95% CI, -0.17 to 0.31) across 3 studies. There were also no significant differences in nausea/vomiting, hypoglycemia, pneumonia, and mortality.

This synthesis of emergent clinical trial data suggests that nonfasting protocols for cardiac procedures are safe and associated with improved patient satisfaction. This study supports updating fasting guidelines for lower risk invasive cardiac procedures.