Clinical trial confirms that fasting is not needed before catheterization lab procedures

There was no distinction in considerations in sufferers who fasted or did no longer speedy earlier than cardiac catheterization procedures requiring awake sedation, fixed with gradual-breaking analysis offered in a Sizzling Line session Sept. 1 at ESC Congress 2024.

“Fasting earlier than a cardiac catheterization draw has been urged to in the good buy of the probability of inhaling the abdomen contents and creating aspiration pneumonia. On the different hand, for procedures in the catheterization lab, fasting might perchance no longer in the good buy of aspiration probability and there are downsides, corresponding to patient discomfort, water depletion, unfortunate blood sugar wait on watch over and needless fasting for delayed/canceled procedures.

“In the SCOFF trial, we had been in a net site to uncover no elevated probability of considerations with fashioned ingesting and that is proper news for sufferers and for properly being care professionals,” said Valuable Investigator, Dr. David Ferreira of the John Hunter Hospital, Newcastle, Australia.

The investigator-initiated, randomized SCOFF trial, with a prospective launch-model, blinded endpoint create, assessed the non-inferiority of no fasting old to cardiac catheterization laboratory procedures requiring awake sedation.

Patients who had been referred for coronary angiography, coronary intervention or cardiac implantable digital tool-linked procedures had been recruited. They had been randomized 1:1 to fasting earlier than the draw (no solid meals for six hours and no hump liquids for two hours) or to no fasting the attach the patient was encouraged to bear customary meals as customary, nonetheless this was no longer the largest.

The valuable composite endpoint was hypotension, aspiration pneumonia, hyperglycemia and hypoglycemia assessed with a Bayesian reach.

Secondary endpoints included distinction-introduced on nephropathy, original intensive care admissions post-draw, original air waft requirements post-draw, original intensive care unit admissions, 30-day readmissions, 30-day mortality, 30-day pneumonia and pre-draw patient pride.

In total, 716 sufferers had been recruited from six websites in New South Wales, Australia. The indicate age was 69 years and 35% had been female. As expected, fasting cases had been longer with fasting when put next with out a fasting (solid fasting 13.2 hours vs. 3.0 hours, hump liquid fasting 7.0 hours vs. 2.4 hours).

The valuable composite came about in 19.1% in the fasting team and 12.0% in the no-fasting team. In an blueprint to contend with analysis, the estimate of the indicate posterior distinction was −5.2% (95% self belief interval [CI] −9.6 to −0.9) favoring no fasting. This end result confirmed the non-inferiority of no fasting, based utterly on a non-inferiority margin of three% with a probability of elevated than 99.5%.

No fasting was also doubtlessly superior to fasting for the valuable with a probability of 99.1%. There was an absolute probability distinction between the groups of 7.1% in prefer of no fasting, with a quantity the largest to contend with of 14.1 to forestall one valuable match.

In analyses of secondary events, no obvious variations had been seen with out and with fasting. Patient pride was significantly greater with out fasting vs. with fasting when assessed by the usage of a questionnaire: 11 vs. 15 aspects the attach a lower rating signifies elevated pride (posterior indicate distinction, 4.02 aspects; 95% CI 3.36 to 4.67; Bayes aspect ≥100).

“Taken alongside side data from the CHOW-NOW, TONIC and the Rapidly-CIED trials and from quite about a observational experiences, there is now a strong case that fasting is no longer the largest in sufferers present process most of these procedures.

“Doing away with fasting has been consistently confirmed to be actual, sufferers regularly prefer no longer to speedy and there are logistical advantages to the properly being care system if sufferers can eat and drink customarily.

“With this original proof, I non-public it’s now time to reassess fasting requirements in clinical pointers,” concluded Dr. Ferreira.