The shift to computed tomography angiography (CTA) as a first-line diagnostic for coronary artery disease (CAD) is no longer theoretical—it’s already underway. As we explored in the first installment of this series, noninvasive CTA is steadily replacing invasive catheterization procedures, prompting health systems to rethink financial models, redefine physician roles, and retool day-to-day operations.
The biggest disruption that leaders must navigate is the evolving role of the cath lab since, as diagnostic labs decline, so too does traditional cath lab volume. But that doesn't signal obsolescence—it means opportunity. With the right strategy, health systems can optimize this transition to boost procedural volumes, improve access, and elevate the performance of the broader cardiovascular (CV) service line.
The Changing Role of the Cath Lab
While cath labs have historically relied on a steady flow of diagnostic procedures, advances in noninvasive imaging (CTA, cardiac MRI, stress testing, etc.) and AI-based risk stratification are cutting into the volume of diagnostic angiography. Future cath labs won’t be empty, but how they're used will look a bit different, as evidenced by the following trends:
- Fewer patients are undergoing caths for diagnosis. CTA is eliminating unnecessary invasive procedures. CTA has proven to be an effective, lower-risk diagnostic, preventing the need for invasive coronary angiography (ICA) in 77% of patients with stable chest pain and boasting lower rates of coronary revascularization and stroke compared to ICA. As a result, diagnostic caths are no longer the default, they are a downstream exception.
- CTA is increasingly being used for preprocedure planning and early CAD detection. With more patients being diagnosed and risk-stratified through noninvasive means, the cath lab’s procedural focus is increasingly shifting to treatment rather than investigation. This shift increases the clinical complexity of cases handled in the cath lab and reinforces its role as a downstream, high-acuity setting in CV care.
- Interventional cases are growing in complexity. With fewer diagnostic caths being performed, the cases that remain in the cath lab tend to be more complex, requiring longer procedures and more specialized expertise.
The Cath Lab of the Future
Tomorrow's cath lab won't be defined by how many patients pass through it, but by how well it serves as a hub for complex, coordinated, high-value care. To thrive in this new environment, health systems will need to adapt across three primary areas: procedural mix, physician roles, and strategic capacity.
Shifting Procedural Volumes
With fewer diagnostic caths, CV service line leaders need to effectively backfill lost procedural volume, which could include the strategies below.
- Drive Interventional Case Growth: The transition away from diagnostic caths means that cath lab volume will likely tilt toward higher-acuity interventions (e.g., percutaneous coronary interventions [PCIs], peripheral vascular interventions), higher volumes of structural heart procedures (e.g., TAVR, MitraClip), and increased observation and inpatient bed demand as more patients require postprocedure monitoring. To support this transition, leaders should invest in referral management, ensure seamless coordination between imaging and interventional teams, and equip labs with the staffing and resources needed to handle increased procedural complexity.
- Expand Electrophysiology (EP) Services: Demand for EP services, including pacemakers, ablations, and device implants, is projected to increase 38% over the next 10 years, driving the expansion of these services within cath labs (according to ECG’s 2023 Advisory Board Market Estimator). As CTA and other modalities absorb more of the diagnostic workload, systems can capitalize on the freed-up cath lab space to address patients’ growing EP needs. To do so, however, leaders must plan carefully. EP procedures often require additional specialized equipment, and retrofitting cath labs for EP can strain existing room configurations and space availability.
- Optimize Workflows: In a lower-volume, higher-acuity environment, efficiency is everything. Streamlining operational workflows can help maximize the value of each interventional slot. A few tactics for consideration are detailed below.
- Reducing downtime between cases: With fewer diagnostic caths filling schedules, hospitals must ensure interventional slots are fully utilized.
- Rethinking staffing models: Redesigning team roles, such as expanding the use of APPs and other providers for pre- and postprocedure care, can help increase procedural capacity, reduce delays, and keep interventional workflows efficient.
- Enhancing access: If interventional cases increase in complexity, health systems may need to explore more strategic ways to increase access.
Shifting Physician Roles
As procedural volume shifts, so too will the roles of interventional cardiologists and other CV specialists. Service line leaders must proactively plan for this evolution or risk misalignment between clinical workflows, staffing, and capacity.
- Interventional cardiologists will increasingly focus on high-value, complex interventions. The days of interventionalists performing routine diagnostic caths are dwindling, meaning their caseload will include more procedures that directly impact patient outcomes.
- General cardiologists may need to adjust referral patterns. As CTA and other diagnostics take on a larger role, general cardiologists may need to rethink how and when they send patients for invasive evaluation. Instead of simply handing patients off to the cath lab, these providers will increasingly be expected to interpret imaging results, contribute to shared decision-making, and remain actively involved in managing care before and after any procedure.
- Cardiac imagers will play a central role in identifying procedural candidates. Cardiologists trained in CTA, cardiac MRI, and other advanced modalities will increasingly influence not just diagnosis but also lab utilization. Their role will involve stratifying patient risk, coordinating with interventional teams, and translating imaging into actionable procedural decisions—all of which help ensure the appropriate and efficient use of cath lab resources.
- EP and vascular specialists will become more prominent players. As capacity opens and demand for noncoronary interventions rises, these subspecialists will occupy more lab time, requiring better scheduling models and deeper integration into service line strategy.
Shifting Opportunities
On the surface, the move from cath-based diagnostics to CTA and other noninvasive diagnostics appears disruptive; however, health systems likely need cath lab capacity more than ever. Instead of viewing declining diagnostic cath volume as a loss, proactive service line leaders will optimize newly available cath lab space for long-term strategic growth in light of the trends below.
- Structural heart programs are growing rapidly. The TAVR market, which was valued at $2.6 billion in 2024, is projected to grow at a CAGR of 5.9% from 2025 to 2030. With TAVR and mitral intervention programs expanding, many hospitals are already grappling with cath lab capacity constraints—and that pressure is only increasing.
- EP is seeing a surge in demand. Rhythm management procedures are accelerating in volume and complexity, requiring additional dedicated time and space. More cath lab availability translates to greater EP access.
- Vascular procedures are on the rise. Approximately 6.5 million people ages 40 and older in the United States have peripheral arterial disease (PAD). With the aging population and increasing PAD prevalence, cath labs can be a natural hub for peripheral interventions.
- CAD is being detected earlier, lowering the need for invasive intervention. With its ability to provide more accurate and timely diagnoses, CTA is driving more PCI referrals and reducing the need for surgical intervention.
Strategic Takeaways: Four Priorities for Service Line Leaders
The transition from cath-based diagnostics to CTA is an inflection point for the cath lab. In the years ahead, CV leaders will face a fundamental question: How do we reallocate cath lab capacity to ensure continued service line growth and financial sustainability?
In response, health systems should develop a proactive strategy built on the following priorities to support a stronger, more sustainable model for the future.
- Priority One: Invest in interventional growth areas such as structural heart, EP, and vascular interventions.
- Priority Two: Ensure physician alignment to help interventional cardiologists, general cardiologists, and imaging specialists adjust to their new roles.
- Priority Three: Redesign cath lab scheduling and resource allocation to accommodate the shift toward higher-acuity, longer-duration procedures while optimizing workflow efficiency to maximize utilization and improve throughput for complex interventions.
- Priority Four: Prepare for payer shifts as payers incentivize certain procedures over others in response to evolving reimbursement models.
Next in the Series: A Reality Check on Cath Lab Migration to ASCs
Stay tuned for the next installment in our series, where we will take a closer look at the ASC opportunity related to CV care, including tailwinds driving the interest, headwinds limiting migration, and key considerations for health systems exploring this option.
Edited by Emily Johnson
