Trial reportJACC. Cardiovascular interventions2024
A Randomized Controlled Trial of Nonfasting vs Fasting Before Interventional Coronary Procedures: The TONIC Trial.
Trial report in JACC. Cardiovascular interventions, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Journal of the American Heart Association · 2025Pooled it
- Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association.Circulation · 2026Review
- Precision percutaneous coronary intervention.NPJ cardiovascular health · 2026Review
- Comparison between no fasting vs. fasting in patients undergoing cardiac catheterization laboratory procedures: a systematic review and meta-analysis.European heart journal open · 2026Article
- Fasting Versus Non-fasting Protocols Before Cardiac Catheterization Procedures: A Meta-analysis of Clinical Trials.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Review
- Should we unfasten our patients? A meta-analysis of randomized trials on fasting prior to cardiac catheterization procedures.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Advanced Haemodynamic Monitoring During Transfemoral Aortic Valve Replacement: A Prospective Pilot Study.Life (Basel, Switzerland) · 2025Article
- Fasting Guidelines for Invasive Cardiac Procedures: Let Them Eat Cake!Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
- Re-evaluating Fasting Guidelines for Invasive Cardiac Procedures: A Systematic Review and Meta-analysis of Randomized Clinical Trials.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
- Nutrition Optimization Among Critically Ill Patients in the Cardiac Intensive Care Unit.Current cardiology reports · 2025Review
- Response to Letter to the Editor Regarding the CALORI Trial.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
- Reconsidering Pre-Procedural Fasting for Elective Percutaneous Cardiac Procedures.Circulation. Cardiovascular interventions · 2025Article
- Non-fasting versus fasting before percutaneous cardiac procedures: a systematic review and meta-analysis of randomized controlled trials.Perioperative medicine (London, England) · 2025Review
- Assessing the Likelihood of Procedural Intubation During Percutaneous Coronary Intervention.Journal of the American Heart Association · 2025Article
- Prolonged pre-catheterization fasting: do the risks outweigh the benefits?Cardiovascular diagnosis and therapy · 2024Article
- Review
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFasting before coronary procedures is currently recommended to reduce complications despite the lack of scientific evidence.
objectivesThe TONIC (Comparison Between Fasting and No Fasting Before Interventional Coronary Intervention on the Occurrence of Adverse Events) noninferiority trial investigated 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.
methodsIn this monocentric, prospective, single-blind randomized controlled trial, 739 patients undergoing coronary procedures were included and randomized to a fasting or a nonfasting strategy. Emergency procedures were excluded. The primary endpoint was a composite of vasovagal reaction, hypoglycemia (defined by blood sugar ≤0.7 g/L), and isolated nausea and/or vomiting. Noninferiority margin was 4%. Secondary endpoints were contrast-induced nephropathy and patients' satisfaction.
resultsAmong 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 30 of 365 nonfasting patients (8.2%) vs 37 of 374 fasting patients (9.9%), demonstrating noninferiority (absolute between-group difference, -1.7%; 1-sided 95% CI upper limit: 1.8%). No food-related adverse event occurred, and contrast-related acute kidney injuries were similar between groups. Overall, procedure satisfaction and perceived pain were similar in both groups, but nonfasting patients reported less hunger and thirst (P < 0.01). In case of redo coronary procedures, most patients (79%) would choose a nonfasting strategy.
conclusionsThe TONIC randomized trial demonstrates the noninferiority of a nonfasting strategy to the usual fasting strategy for coronary procedures regarding safety, while improving patients' comfort.
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Registered trials
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