Fasting before coronary angiography, PCI may not be necessary
Asking patients to fast before undergoing interventional coronary procedures may not be beneficial, according to new data published in JACC: Cardiovascular Interventions.[1] In addition, allowing patients to eat before treatment improves patient comfort and decreases the risk of cancelation.
“Fasting before coronary angiographies has been routine practice since the first procedures in the 1960s, with severe complications requiring intubation frequently occurring,” wrote first author Madjid Boukantar, MD, an interventional cardiologist with Henri Mondor Hospital in France, and colleagues. “Such complications are now exceptional, but fasting is still recommended in the guidelines despite the absence of scientific evidence.”
Boukantar, et al. tracked data from more than 700 patients undergoing angiography and/or percutaneous coronary intervention (PCI) from May 2020 to July 2021. All patients were treated at a single interventional cardiology department in France. While one group of 379 patients was asked fast before the procedure like normal, a second group of 376 patients was allowed to eat and drink before treatment. The two groups had comparable baseline characteristics, including similar mean ages (67 years old for the fasting group vs. 68 years old for the nonfasting group).
Overall, the study’s primary outcome—a vasovagal reaction, hypoglycemia or isolated nausea and/or vomiting—was seen in 9.9% of fasting patients and 8.2% of nonfasting patients. This was close enough, the authors determined, that nonfasting can be considered noninferior to fasting. Nonfasting was also found to be noninferior if only focusing on one of the specific components of that primary outcome; vasovagal reactions, for instance, occurred in 2.7% of nonfasting patients and 5.4% of fasting patients.
Rates of contrast-induced acute kidney injury and pneumonia were also comparable between the two groups. Also, the authors added, “no adverse events related to food intake occurred.”
The team’s analysis also examined how patients felt about being able to eat and drink ahead of an interventional coronary procedure. As one may expect, patients in the nonfasting group were less likely to report feelings of hunger or thirst. However, satisfaction was ultimately similar between the two groups.
“This reinforces the idea that what probably matters is not the food intake in itself but patients’ beliefs and perception of the waiting time and the procedure,” the authors wrote. “If a patient is convinced fasting is better, forcing him to eat would probably be detrimental to his well-being and likely to induce a nocebo effect. Thus, patients should be informed that eating is safe, and then be free to decide.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.