Is fasting required prior to coronary angiography?

Patients undergoing a shorter-than-recommended fasting period prior to coronary angiography have significantly higher satisfaction scores, according to a study. This finding highlights the feasibility of revised fasting protocols.

“Similar to procedures requiring general anaesthesia, current guidelines recommend fasting for 6 hours for solids and for 2 hours for liquids prior to coronary angiography, but without data supporting such recommendation,” the investigators said.

This single-centre, randomized, prospective, pragmatic study was conducted in two sequential phases: a conventional protocol phase (F group) continuing the usual practice and an experimental phase (NF group) reducing the minimum fasting duration to 2 hours.

Patients completed a questionnaire to express a satisfaction score ranging from 1 (maximum complain/no approval) to 5 (minimum or no complain/full approval). All participants admitted acutely were enrolled in a control A group registry. The investigators then analysed fasting time and every major complication and periprocedural complications.

Fasting time was 821 min in the F group and 230 min in the NF group (p<0.001). The NF group had a higher satisfaction than the F group (4.2 vs 2.9; p<0.001) even at multivariable analysis considering fasting time (p<0.001).

Of note, intraprocedural food ingestion-related adverse events did not occur in either NF or F groups, as well as in the parallel A group. There were also no excess of peri- and postprocedural complications in the NF group.

“The significantly higher satisfaction scores among patients undergoing a shorter-than-recommended fasting period prior to coronary angiography, not counterbalanced by decreased safety, underscores the potential benefits of revising the traditional 6-hour fasting protocols,” the investigators said.