Fasting prior to cath lab procedures requiring conscious sedation may not be needed, based on findings from the SCOFF trial presented at ESC Congress 2024 in London.

Researchers randomly assigned 716 patients (mean age 69 years; 35% women) who were referred for coronary angiography, coronary intervention or cardiac implantable electronic device-related procedures to either fast before the procedure (no solid foods for six hours/no clear liquids for two hours) or to have regular meals as usual.

The primary composite outcome of hypotension, aspiration pneumonia, hyperglycemia and hypoglycemia occurred in 19.1% of patients in the fasting group and 12.0% in the no-fasting group. Researchers noted that in an intention to treat analysis, the estimate of the mean posterior difference was −5.2% favoring no fasting.

In other findings, researchers said no apparent differences were observed between the two groups in terms of contrast-induced nephropathy, new intensive care admissions post-procedure, new ventilation requirements post-procedure, new intensive care unit admissions, 30-day readmissions, 30-day mortality and 30-day pneumonia. Patient satisfaction was also significantly better among those who didn't fast compared with those who did.

"In the SCOFF trial, we were able to show no increased risk of complications with normal eating and that is good news for patients and for health care professionals," said Principal Investigator David Ferreira, MD. "Taken together with data from the CHOW-NOW, TONIC and the Fast-CIED trials and from various observational studies, there is now a strong case that fasting is not needed in patients undergoing these types of procedures. With this new evidence, I think it is now time to reconsider fasting requirements in clinical guidelines."