Feasibility and Clinical Consequences of Liberal Fasting Compared to Standard Practice Prior to Elective Coronary Angiography: Results from a Randomized Trial.

BACKGROUND: Pre-procedural fasting is routinely recommended before coronary angiography and percutaneous coronary intervention (PCI), largely based on guidelines developed for procedures involving sedation or anesthesia. However, prolonged fasting may cause dehydration, hypoglycemia, electrolyte disturbances, acute kidney injury, and patient discomfort, particularly when procedures are delayed. Recent randomized and observational studies suggest that non-fasting strategies may be safe in selected patients undergoing elective or semi-urgent coronary procedures, with no apparent increase in aspiration or other major adverse events. This paper aims to compare the feasibility and efficacy of fasting versus non-fasting protocols in patients undergoing elective coronary angiography. METHODS: In this single-center, prospective, parallel-group, blinded endpoint, randomized controlled trial, we randomized participants in a 1:1 ratio to either the fasting or non-fasting group using a simple randomization method to evaluate the effects of fasting versus non-fasting protocols before elective coronary angiography. The primary endpoints of this study were the occurrence of fasting-related and procedure-related complications, including aspiration, vomiting, hypoglycemia (defined as a blood glucose level below 70 mg/dL), agitation, and post-procedural serum creatinine measurements. RESULTS: From January 2024 to March 2025, 110 eligible patients were enrolled and randomized to either the fasting group (n = 55) or the non-fasting group (n = 55). All randomized participants completed the study and were included in the final analysis. Baseline demographic and clinical characteristics were comparable between the two groups. Only one case of vomiting was observed in the non-fasting group, with no cases of aspiration, hypoglycemia, or agitation reported in either group. There was no significant difference in serum creatinine levels between the non-fasting and fasting groups (1.10 ± 0.18 mg/dL vs. 1.10 ± 0.24 mg/dL; P = 0.473). Similarly, the mean length of hospital stay was comparable between groups (2.3 ± 1.5 days vs. 2.4 ± 1.5 days; P = 0.849). CONCLUSION: In this randomized controlled trial, liberal fasting practices before elective coronary angiography were not associated with an observed increase in short-term adverse events.