Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials
Background Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta‐analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisf...
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| Format: | Article |
| Language: | English |
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Wiley
2025-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040445 |
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| author | Adil Salihu Stephane Fournier Sarah Hugelshofer Quentin Liabot Victor Weerts Georgios Tzimas Valentina Rancati Clemence Ferlay Aurelia Zimmerli Olivier Muller Henri Lu Panagiotis Antiochos Orestis Efthimiou David Meier |
| author_facet | Adil Salihu Stephane Fournier Sarah Hugelshofer Quentin Liabot Victor Weerts Georgios Tzimas Valentina Rancati Clemence Ferlay Aurelia Zimmerli Olivier Muller Henri Lu Panagiotis Antiochos Orestis Efthimiou David Meier |
| author_sort | Adil Salihu |
| collection | DOAJ |
| description | Background Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta‐analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction. Methods We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study‐specific results in meta‐analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction. Results We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta‐analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78–1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (−1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11–1.13). Conclusion Our meta‐analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465; Unique identifier: CRD42024595465. |
| format | Article |
| id | doaj-art-ae2a8cc5bb854a0499126d8bf9e6028b |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-ae2a8cc5bb854a0499126d8bf9e6028b2025-08-20T03:14:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-06-01141110.1161/JAHA.124.040445Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical TrialsAdil Salihu0Stephane Fournier1Sarah Hugelshofer2Quentin Liabot3Victor Weerts4Georgios Tzimas5Valentina Rancati6Clemence Ferlay7Aurelia Zimmerli8Olivier Muller9Henri Lu10Panagiotis Antiochos11Orestis Efthimiou12David Meier13Service of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Anesthesiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern Bern SwitzerlandService of Cardiology Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandBackground Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta‐analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction. Methods We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study‐specific results in meta‐analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction. Results We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta‐analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78–1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (−1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11–1.13). Conclusion Our meta‐analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465; Unique identifier: CRD42024595465.https://www.ahajournals.org/doi/10.1161/JAHA.124.040445cardiac catheterizationfastingpercutaneous coronary intervention |
| spellingShingle | Adil Salihu Stephane Fournier Sarah Hugelshofer Quentin Liabot Victor Weerts Georgios Tzimas Valentina Rancati Clemence Ferlay Aurelia Zimmerli Olivier Muller Henri Lu Panagiotis Antiochos Orestis Efthimiou David Meier Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac catheterization fasting percutaneous coronary intervention |
| title | Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials |
| title_full | Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials |
| title_fullStr | Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials |
| title_full_unstemmed | Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials |
| title_short | Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta‐Analysis of Randomized Clinical Trials |
| title_sort | fasting before cardiac catheterization still necessary a systematic review and meta analysis of randomized clinical trials |
| topic | cardiac catheterization fasting percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040445 |
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