No Benefit to Fasting Before Catheterization Procedures: SCOFF Trial
New research presented at ESC Congress 2024 shows that fasting or not fasting before cardiac catheterization procedures with conscious sedation does not affect the rate of complications.
The SCOFF trial, a randomized study with an open-label design and blinded endpoints, evaluated whether not fasting before cardiac catheterization procedures requiring conscious sedation was as effective as fasting.
Patients scheduled for coronary angiography, coronary interventions, or procedures involving cardiac implantable electronic devices were included. They were randomly assigned to either fast before the procedure (no solid food for 6 hours and no clear liquids for 2 hours) or to eat normally with no strict fasting requirements.
The main combined measure of the study focused on hypotension, aspiration pneumonia, hyperglycemia, and hypoglycemia, evaluated using a Bayesian method.
Secondary measures included contrast-induced nephropathy, new admissions to intensive care following the procedure, new ventilation needs post-procedure, new ICU admissions, readmissions within 30 days, mortality within 30 days, 30-day pneumonia rates, and patient satisfaction before the procedure.
In total, 716 patients were recruited, the mean age was 69 years and 35% were female. As expected, fasting times were longer with fasting compared with no fasting (solid fasting 13.2 hours vs. 3.0 hours, clear liquid fasting 7.0 hours vs. 2.4 hours).
The results showed that not fasting before the procedure is just as safe as fasting. In fact, not fasting might even be slightly better for avoiding complications, with a 99.1% chance of being more effective. On average, the risk of complications was 7.1% lower for those who didn’t fast compared to those who did. For every 14 patients who don’t fast, one fewer person experienced a complication.
When looking at secondary outcomes, there were no noticeable differences between fasting and not fasting. However, patients who didn’t fast reported significantly higher satisfaction.
Reference: SCOFF - Fasting or no fasting before cardiac catheterisation procedures’ discussed during Hot Line 8 on Sunday 1 September in room London.
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