Salihu Adil, Fournier Stephane, Hugelshofer Sarah, Liabot Quentin, Weerts Victor, Tzimas Georgios, Rancati Valentina, Ferlay Clemence, Zimmerli Aurelia, Muller Olivier, Lu Henri, Antiochos Panagiotis, Efthimiou Orestis, Meier David
Service of Cardiology Lausanne University Hospital and University of Lausanne Lausanne Switzerland.
Service of Anesthesiology Lausanne University Hospital and University of Lausanne Lausanne Switzerland.
J Am Heart Assoc. 2025 Jun 3;14(11):e040445. doi: 10.1161/JAHA.124.040445. Epub 2025 May 22.
Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta-analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction.
We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study-specific results in meta-analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction.
We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta-analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78-1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (-1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11-1.13).
Our meta-analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context.
URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465; Unique identifier: CRD42024595465.
通常建议在择期或非紧急冠状动脉造影术前禁食，以降低不良事件的风险，如吸入性肺炎。本系统评价和荟萃分析旨在评估禁食方案与非禁食方案对患者结局和满意度的影响。
我们系统检索了PubMed、Embase和Cochrane图书馆数据库，以查找比较心脏导管插入术前禁食和非禁食状态的随机临床试验。主要结局是包括肺炎、低血糖和恶心/呕吐在内的不良事件的综合指标。次要结局包括个体不良事件和患者满意度。对于每个二元结局，我们估计了每个治疗组的粗事件概率。接下来，我们在荟萃分析中汇总了研究特异性结果，使用比值比（OR）和风险差作为二元结局的效应量，使用标准化均差作为满意度的效应量。
我们确定了8项随机临床试验，共纳入3147例患者。我们的荟萃分析显示，在OR值方面，禁食组和非禁食组在综合不良事件发生率上没有差异（OR，1.08，[95%CI，0.78-1.51]，其中OR<1支持禁食）。禁食组和非禁食组的粗事件概率分别为4.9%和4.4%，估计风险差=0.4%（-1.1%至1.8%），其中风险差<0支持禁食。发现非禁食方案中的患者满意度更高，标准化均差为0.62（0.11-1.13）。
我们的荟萃分析没有发现证据表明择期冠状动脉造影术前禁食能减少不良事件。然而，我们发现禁食会降低患者满意度。这些发现对这种情况下禁食方案的必要性提出了质疑。
网址：https://www.crd.york.ac.uk/PROSPERO/view/CRD42想了解24595465；唯一标识符：CRD42024595465。
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