1 Introduction Despite a lack of scientific evidence, fasting has been a longstanding practice before cardiac catheterization [ 1 ]. The older generation ionic, high-osmolar contrast agents were associated with increased likelihood of nausea and vomiting [ 2 ]. The potential increased risk of aspiration was especially in cases where conscious sedation was used [ 3 ]. Another reason was the relatively high need for emergency interventions and the risk of aspiration at time of induction of general anesthesia for intubation [ 4 ]. However, modern contrast agents like low- and isoosmolality non-ionic iodinated contrast media have much lower rates of nausea and vomiting and the reduced risk of aspiration [ 5 ]. In parallel, the need for urgent surgery has decreased significantly [ 6 ]. Recent studies have questioned the rationale behind this practice. Hence, this commentary aims to explore the need for fasting before cardiac catheterization and provide evidence-based recommendations for clinical practice.