Do We Need Fasting Prior to Coronary Angiography? The CORO-NF Randomized Pragmatic Study

Background Similar to procedures requiring general anesthesia, current guidelines recommend fasting for 6 h for solids and for 2 h for liquids before coronary angiography, but without data supporting such recommendation. Objective The CORO-NF study aimed at assessing whether a shorter fasting before elective coronary angiography associates with improved patient satisfaction without more complications compared with the standard fasting approach. Methods We conducted a single-center, randomized, prospective, pragmatic study in two sequential phases: a “conventional protocol phase”, continuing the usual practice (F Group); and an “experimental phase” (NF Group), reducing minimum fasting duration to 2 h. Patients received a questionnaire to express a satisfaction score ranging from 1 (maximum complain/no approval) to 5 (minimum or no complain/full approval). All patients admitted acutely were enrolled in a control A Group registry. Fasting time and every major complication and periprocedural complications were analysed. Results Fasting time was 821±357 min in the F Group and 230±146 min in the NF Group (p<0.001). The satisfaction score was higher in the NF Group (4.2±0.7 versus 2.9±1.2, p<0.001), even at multivariable analysis considering fasting time (p<0.001). No intra-procedural food ingestion-related adverse events occurred in any of the two experimental group, as well as in the parallel A Group, with no excess of peri- and postprocedural complications in the NF Group. Conclusions The significantly higher satisfaction scores among patients undergoing a shorter-than-recommended fasting period before coronary angiography, not counterbalanced by decreased safety, underscores the potential benefits of revising the traditional 6-h fasting protocols.