The Green Cath Lab Challenge: Environmental Sustainability in Interventional Cardiology

Healthcare systems are responsible for a significant share of global greenhouse gas emissions, and cardiac catheterization laboratories (CCLs) are among the most resource-intensive hospital units due to their reliance on single-use materials, high-energy imaging systems, and strict infection-control protocols. Understanding and mitigating their environmental impact is essential for achieving sustainable cardiovascular care. The aim of this review was to summarize and analyze available quantitative evidence on waste generation, recycling potential, and carbon emissions in interventional cardiology, and to identify practical strategies for transitioning toward a "green cath lab." A structured literature search was conducted across PubMed, Scopus, and Web of Science for the period 2015-2025, supplemented by Google Scholar and the cardiovascular society websites. Studies were eligible if they provided quantitative data on waste output, recycling rates, or carbon footprint in CCLs. Out of 357 retrieved records, only four met all inclusion criteria. Diagnostic coronary angiography produced an average carbon footprint of 12.5 kg CO₂-equivalent per case, with single-use disposables (40%) and imaging energy (25%) as the largest contributors. Waste audits showed 1.5-3 kg of waste per procedure, 36%-40% of which was recyclable. Optimizing procedural packs, improving heating, ventilation, and air conditioning or HVAC efficiency, and structured waste segregation achieved 20%-30% reductions in waste and emissions without affecting safety. Evidence indicates that interventional cardiology generates measurable and avoidable environmental burdens. Implementing targeted, low-cost interventions can markedly reduce both waste and carbon footprint. These findings establish a quantitative foundation for sustainability frameworks, carbon auditing, and policy initiatives toward a net-zero cath lab.