CALORI Trial Explores Nonfasting Preprocedural Strategy for Cardiac Catheterization

May 2, 2024—The CALORI Cardiac Catheterization trial, which focuses on inpatients undergoing elective or urgent cardiac catheterization procedures, is a single-center, randomized trial investigating the impact of fasting after midnight versus unrestricted oral intake prior to cardiac catheterization.

New data from the CALORI trial shows significant improvement in patient well-being and satisfaction without compromising safety after the implementation of a liberal nonfasting strategy before a cardiac catheterization procedure.

The late-breaking results were presented at SCAI 2024, the Society for Cardiovascular Angiography & Interventions scientific sessions held May 2-4 in Long Beach, California.

As summarized in the SCAI press release, the primary endpoint assessed preprocedural patient satisfaction levels (scaled 0-5 with 0 signifying the absence of variable and 5 the most extreme form) regarding hunger, fatigue, anxiety, and nausea. Additionally, a composite well-being score, incorporating hunger and fatigue, was utilized. Secondary endpoints encompassed postprocedural satisfaction and the occurrence of periprocedural adverse events such as emesis, aspiration, or intubation.

Among the 198 patients analyzed (65% male and 42% Black), the study found the following:

• Nonfasting patients showed significantly better composite preprocedural well-being scores of 2.4 ± 2.4 compared to 6.0 ± 2.5 for those who were withheld from fluids or solids (Nil Per Os [NPO]) (P < .001).
• Nonfasting patients had significantly better individual scores for hunger (0.9 ± 1.5 vs 3.7 ± 1.5; P < .001), fatigue (1.5 ± 1.6 vs 2.3 ± 1.8; P < .001), and nausea (0.1 ± 0.5 vs 0.5 ± 1.2; P = .006).
• Post-procedural satisfaction was significantly higher in the nonfasting group (0.3 ± 0.7 vs 1.0 ± 1.3; P < .001).
• Time from most recent oral intake to procedure start averaged 148 minutes for the nonfasting and 970 minutes for the NPO strategy (P < .001).
• Adverse events did not differ between groups.

Brian Mitchell, MD, an interventional cardiology fellow at Virginia Commonwealth University in Richmond, Virginia, led the study.

“Just as our techniques and technology for cardiac catheterization have evolved, so should our approach to preprocedure management,” commented Dr. Mitchell in the SCAI study. “Few studies have prospectively explored this strategy in such a diverse patient population, and with such liberal nonfasting allowances, making it the most comprehensive and generalizable study on this topic to date. Given our findings, we hope that providers will limit preprocedural fasting to those patients at high risk of aspiration or conversion to general anesthesia.”