The SCOFF Trial Results Scoff at the Pre-Cardiac Cath “NPO” Practice

The SCOFF trial, presented at ESC 2024, challenges the long-standing practice of fasting before cardiac catheterization procedures. Traditionally, patients undergoing these procedures have been required to fast for several hours to reduce the risk of aspiration, a rare but potentially severe complication. However, this standard of care, which mandates fasting for 6 hours for solid food and 2 hours for clear liquids, has been based more on tradition than on robust evidence.

The SCOFF trial, a multicenter, randomized controlled study conducted in New South Wales, Australia, aimed to address this gap by comparing the outcomes of patients who fasted before their catheterization procedures with those who did not. The trial included 716 patients (mean age of 69 years, 35% women), randomized 1:1 to either fasting or no fasting before procedures such as coronary angiography, percutaneous coronary intervention, and device implantation.

The primary composite endpoint included hypotension, hyperglycemia, hypoglycemia, and aspiration pneumonia, occurring in 19.1% of the fasting group and 12% of the non-fasting group. The results demonstrated that non-fasting was non-inferior to fasting, with no significant increase in adverse events in the non-fasting group. In fact, non-fasting was potentially superior with regard to the primary endpoint with a probability of 99.1%. Notably, the study found that patient satisfaction was higher among those who did not fast, with reduced complaints of hunger and thirst.

The clinical relevance of these findings is significant. While the fear of aspiration has historically driven the fasting protocol, the data from the SCOFF trial suggest that this risk may be overestimated, particularly for elective, non-emergent procedures. The trial’s outcomes align with previous smaller studies and observational data, indicating that eliminating fasting could enhance patient comfort without compromising safety.

Notably, these results cannot be extrapolated to those requiring calcium modification, mechanical circulatory support, structural valvular interventions, electrophysiologic studies including mapping and/or ablation, or biventricular device implantation which were all excluded from this trial.

These findings may prompt a re-evaluation of fasting protocols in cardiac catheterization labs, potentially leading to changes in guidelines and practice. By reducing unnecessary fasting, healthcare systems could improve procedural efficiency, reduce delays, and enhance overall patient care, particularly in high-volume centers.