BACKGROUND AND OBJECTIVE: Despite the absence of scientific evidence, fasting before percutaneous cardiac catheterization is still recommended to minimize complications. This systematic review and meta-analysis aimed to compare the outcomes of non-fasting protocols in patients undergoing percutaneous cardiac procedures. MATERIALS AND METHODS: A systematic search of PubMed, Scopus, WOS, Embase, and Cochrane was conducted until September 2024. Dichotomous outcomes were pooled using risk ratio (RR), while continuous outcomes were pooled using standardized mean difference (SMD). PROSPERO ID: CRD42024586147. RESULTS: Five RCTs with 2034 patients were included. There was no significant difference between both groups regarding patient satisfaction score [SMD - 0.65, 95% CI (- 1.39, 0.09), P = 0.08], intra/postoperative aspiration (RR 1.00, 95% CI [0.20, 4.96], P = 1.00), postprocedural pneumonia (RR 0.60, 95% CI [0.14, 2.51], P = 0.49), emergency endotracheal intubation (RR 0.99, 95% CI [0.10, 9.51], P = 1.00), nausea/vomiting (RR 0.89, 95% CI [0.46, 1.76], P = 0.75), anti-emetic use (RR 0.49, 95% CI [0.24, 1.03], P = 0.06), hypoglycemia (RR 0.74, 95% CI [0.43, 1.28], P = 0.28), and the need for inotrope/vasopressor therapy (RR 1.03, 95% CI [0.81, 1.30], P = 0.82). However, the non-fasting approach significantly decreased the sensation of tiredness/fatigue (SMD - 0.31 with 95% CI [- 0.51, - 0.11], P <
0.002). CONCLUSION: The non-fasting protocol demonstrated comparable efficacy, safety, and overall satisfaction to the conventional fasting approach. REVIEW REGISTRATION : PROSPERO CRD42024586147.