Comparison of Fasting and Nonfasting Regimens Outcomes Before Catheterization Laboratory Procedures: A Systematic Review and Meta-Analysis

Guidelines recommend fasting before catheterization laboratory (cath lab) procedures. However, recent studies question the necessity of fasting, suggesting that fasting may not provide significant clinical benefits. This study aims to evaluate the existing evidence between outcomes for patients with fasting and nonfasting regimens. We conducted a comprehensive search for randomized controlled trials comparing fasting and nonfasting protocols before cath lab procedures. Outcomes included hypoglycemia, aspiration pneumonia, contrast nephropathy, all-cause mortality, and cardiovascular mortality. A random effects meta-analysis was performed to derive odds ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis included 8 randomized controlled trials with a total of 3068 participants: 1544 in the fasting group and 1524 in the nonfasting group. Compared with fasting, nonfasting was not associated with significant differences in hypoglycemia (OR = 0.77, 95% CI, 0.44-1.34), aspiration pneumonia (OR = 1.33, 95% CI, 0.38-4.72), contrast nephropathy (OR = 1.82, 95% CI, 0.88-3.75), all-cause mortality (OR = 1.29, 95% CI, 0.51-3.28), or cardiovascular mortality (OR = 0.94, 95% CI, 0.22-4.05). Nonfasting regimens show no significant differences in safety outcomes compared with fasting, suggesting it may be implemented to improve patient experience without compromising safety. Larger trials are needed to confirm the safety of nonfasting regimens. Summary of outcomes (CEID, cardiac implantable electronic device; PCI, percutaneous coronary intervention; TAVR, transcatheter aortic valve replacement). The design features graphical elements sourced from Servier Medical Art, which are provided by Servier under the Creative Commons Attribution 4.0 unported license.