Fasting Versus Non-fasting Protocols Before Cardiac Catheterization Procedures: A Meta-analysis of Clinical Trials

Background Recent trials suggest that liberalizing oral intake prior to cardiac catheterization procedures improves patient satisfaction and is as safe as the traditional practice of "nothing by mouth." We aimed to compare the outcomes of fasting and nonfasting protocols before such procedures. Methods We searched PubMed and Cochrane Library until May 1, 2025, for clinical trials comparing fasting and nonfasting protocols for a variety of cardiac catheterization procedures. Outcomes of interest were all-cause mortality, aspiration, hypoglycemia, hyperglycemia, nausea/vomiting, contrast-induced nephropathy, and hypotension. Risk ratios (RR) with 95% CI were calculated using the inverse variance method, and quality was assessed using the Cochrane Risk of Bias 2.0 tool. Results We included 9 trials comparing fasting and nonfasting protocols, with a total sample of 3646 patients. We found no significant differences between the 2 groups for mortality (RR, 1.36; 95% CI, 0.55-3.36; I 2 = 0%, χ 2 P = .78), aspiration (RR, 2.14; 95% CI, 0.28-16.53; I 2 = 0; χ 2 P = .44), nausea/vomiting (RR, 0%; 95% CI, 0.62-1.53; I 2 = 0%; χ 2 P = .74), or other outcomes. Patient satisfaction was greater in the nonfasting group in most trials, although heterogenous reporting precluded quantitative synthesis. Eight of the included studies had low risk of bias or some concerns. Conclusions We found that the nonfasting group had similar risk of complications as the fasting group, lending support to liberalizing oral intake prior to these procedures. Our findings provide impetus for standardized, evidence-based protocols in cardiac catheterization.