Allowing patients to eat and drink before coronary procedures as safe as traditional fasting and enhances patient comfort: Study
France: The debate over whether patients should fast before interventional coronary procedures has been a longstanding topic in cardiovascular medicine. The recently concluded TONIC trial, a randomized controlled study, sought to clarify this by comparing outcomes between patients who fasted and those who did not before such procedures.
The study, published in JACC: Cardiovascular Interventions, showed that a nonfasting strategy is noninferior to the usual fasting strategy for coronary procedures regarding safety while improving the comfort of the patients.
These findings indicate that permitting patients to consume food and beverages before coronary procedures is equally safe compared to traditional fasting practices and contributes to enhanced patient comfort. It is recommended that clinicians revise procedural protocols to incorporate nonfasting approaches, potentially improving the overall patient experience without raising the risk of adverse events.
Traditionally, patients undergoing procedures like percutaneous coronary intervention (PCI) or coronary angiography are required to fast overnight. However, growing evidence suggests that fasting may not be necessary and could even lead to discomfort and potential complications. Considering this, Madjid Boukantar, Interventional Cardiology, Henri Mondor Hospital, Créteil, France, and colleagues conducted the TONIC inferiority trial to investigate the safety and comfort of a nonfasting strategy (ad libitum food and drinks) vs traditional fasting (>6 hours for solid food and liquids) before coronary procedures.
The researchers conducted a monocentric, prospective, single-blind randomized controlled trial, including 739 patients undergoing coronary procedures, and randomized to a fasting or a nonfasting strategy. Emergency procedures were excluded.
The primary outcome measure included a combination of vasovagal reactions, hypoglycemia (defined as blood sugar ≤0.7 g/L), and isolated incidents of nausea and vomiting. A noninferiority margin of 4% was applied. Secondary endpoints comprised contrast-induced nephropathy and patient-reported satisfaction levels.
The following were the key findings of the study:
- Among the 739 procedures (697 elective and 42 semiurgent), 517 angiographies, and 222 angioplasties (including complex and high-risk procedures) were performed.
- The primary endpoint occurred in 8.2% nonfasting patients vs 9.9% fasting patients, demonstrating noninferiority (absolute between-group difference, −1.7%).
- No food-related adverse event occurred, and contrast-related acute kidney injuries were similar between groups.
- Procedure satisfaction and perceived pain were similar in both groups, but nonfasting patients reported less hunger and thirst.
- In the case of redo coronary procedures, most patients (79%) would choose a nonfasting strategy.
The TONIC trial showed noninferiority regarding the safety of a nonfasting strategy to the routine fasting strategy for all patients undergoing elective or semi-urgent coronary procedures, with no food-related adverse event.
"A nonfasting strategy could improve patients’ comfort and catheterization laboratories efficiency," the researchers wrote.
Reference:
Boukantar, M., Chiaroni, P., Gallet, R., Zamora, P., Truong, T., Mangiameli, A., Rostain, L., Tuffreau-Martin, A., Natella, P., Oubaya, N., & Teiger, E. (2024). A Randomized Controlled Trial of Nonfasting vs Fasting Before Interventional Coronary Procedures: The TONIC Trial. JACC: Cardiovascular Interventions, 17(10), 1200-1210. https://doi.org/10.1016/j.jcin.2024.03.033
