GLP-1 agonists and cardiac catheterization

A paper published on 11 July 2026 in the American Journal of Cardiology asks a question that cardiologists and anaesthesiologists are increasingly being forced to answer in the cath lab: is it safe to leave patients on semaglutide or tirzepatide before cardiac catheterization with moderate sedation^[1]? The study, authored by Chi, Adhikari, Chang, and colleagues across institutions including Cedars-Sinai and Yale, adds cardiology-specific data to a body of evidence that has been building since anaesthesia societies first flagged the gastric-emptying effect of this drug class in 2023.

Why the question matters

GLP-1 receptor agonists slow gastric emptying. That is part of how they work: food stays in the stomach longer, appetite signals are dampened, and blood glucose rises more gradually after meals. The same mechanism becomes a procedural risk when a patient receives sedation. Retained gastric content raises the chance of regurgitation and aspiration even when standard pre-procedure fasting has been observed. A 2024 meta-analysis of 14 studies covering 2,143 patients found that GLP-1 receptor agonist users had significantly higher residual gastric content despite fasting compliance (odds ratio 6.08; p < 0.00001) compared with non-users^[2]. The same analysis found no significant increase in 30-day mortality, postoperative nausea and vomiting, or perioperative hypoglycemia, but the elevated gastric-content finding has driven most of the clinical debate.

Cardiac catheterization is relevant because it typically uses moderate (not general) sedation. Patients breathe spontaneously throughout. That is reassuring from one angle: the airway is not instrumented the way it is in general anaesthesia, and the aspiration pathway is less predictable. But it also means the protective reflexes that would be suppressed under general anaesthesia remain intact, so a practical question becomes whether those reflexes are enough if gastric content is elevated.

What the surrounding evidence shows

Before the Chi et al. study, most of the procedural-sedation literature came from endoscopy and ophthalmic surgery, not cardiology. A 2024 retrospective study at a large US tertiary centre found that GLP-1 medication users undergoing upper endoscopy had a ninefold higher odds of food retention (OR 9.19; p = 0.0003), with tirzepatide showing the strongest association among the agents examined^[2]. A 2026 observational study of 45,636 ophthalmic surgical visits found that GLP-1 agonist users had a higher rate of nausea requiring antiemetics (OR 1.93; p = 0.001) during mild-to-moderate sedation, but no increase in oxygen desaturation below 90% and zero aspiration events in either group^[3]. The pattern across studies is broadly consistent: gastric-content risk goes up, but documented aspiration events in ambulatory and moderate-sedation settings are rare.

On the medication-management side, a retrospective study examining semaglutide interruption intervals found that patients who stopped semaglutide fewer than 8 days before a procedure had significantly more residual gastric content than non-users, while interruption beyond 14 to 21 days brought levels closer to baseline^[4]. A 2025 multi-society expert consensus from Australia and New Zealand (ADS, ANZCA, GESA, NACOS) recommended continuing GLP-1 agonists through the perioperative period but implementing a 24-hour clear-liquid diet followed by standard six-hour fasting, rather than relying on cessation intervals^[5]. The panel specifically noted that a reliably safe cessation period could not be established because individual variation in gastric emptying on these medications is substantial.

The cardiac catheterization context

Cardiac catheterization introduces a further layer. The patients arriving for coronary angiography or intervention often have acute or unstable presentations where deferring the procedure to allow a medication washout is not clinically feasible. A patient admitted with unstable angina who is also on weekly semaglutide cannot realistically wait two to three weeks for gastric emptying to normalise before diagnostic catheterization. The Chi et al. study directly addresses this scenario: procedures performed with moderate sedation in patients who continued their GLP-1 receptor agonist rather than stopping it.

The study is published ahead of print without an accessible abstract in the indexed record, so the detailed results have not yet been independently confirmed by this editorial team through the full text. What the keywords and institutional affiliations confirm is that the paper examines semaglutide and tirzepatide specifically, in the cardiac catheterization setting, with moderate sedation, at institutions including the Cleveland Clinic Foundation and Yale School of Medicine. The authors declared no competing interests.

What we do not yet know

This literature is still accumulating. Most studies are retrospective and observational. The patient populations, sedation protocols, fasting durations, and GLP-1 agent types vary substantially between studies, making direct comparison difficult. Prospective randomised data comparing continued versus held GLP-1 therapy specifically in the cardiac catheterization setting does not yet exist. The aspiration question is the hardest one to power adequately: the event rate is low enough that very large cohorts are needed to detect a difference, and most procedure-specific registries do not capture medication status at the time of procedure.

The practical guidance for patients is to raise the question with the interventional cardiology or anaesthesia team before the procedure. Whether to continue or hold the medication, and for how long, depends on the clinical urgency, the specific agent and dose, and the institution's protocol. Per-country prescribing rules for semaglutide and tirzepatide are on the relevant peptide pages.