Comparison of long-term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE-CRUSH II registry.

BACKGROUND: Double kissing (DK)-crush and T-stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long-term outcomes of DK-crush and TAP techniques in patients with complex bifurcation lesions. METHODS: A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single-center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. RESULTS: The initial management strategy was DK-crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK-crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK-crush group compared to the TAP group. The long-term TLF was significantly higher in the TAP group compared to the DK-crush group (unadjusted HR: 1.974, [95% CI: 1.044-3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232-5.061], p = 0.011). CONCLUSION: The present study showed that the DK-crush technique of bifurcation treatment was associated with lower long-term TLF and TLR rates compared to the TAP technique.

Environmental deterioration, renewable energy, natural resource rents, and schooling in Türkiye: Does the degree of energy transition matter for environmental quality?

Within the literature on energy and environmental economics, it is generally acknowledged that renewable energy can improve environmental quality; however, certain papers suggest that an optimal level of the usage of renewable energy sources may exist. Consequently, the utilization of renewable energy sources can result in environmental degradation up to a certain threshold. Then, environmental quality can be enhanced through the continued application of renewables. This indicates that the link between renewable energy and environmental devastation is inverted U-shaped. This paper presents empirical evidence concerning this possible association between renewable energy and environmental destruction in Türkiye, a country where fossil energy predominates in the energy mix. Additionally, the paper investigates the environmental influences of natural resource rents and schooling. This study utilizes annual data from 1971 to 2020 and implements time series methodologies that rely on the Fourier approximation. The paper thus accounts for an undetermined quantity of structural breaks. The results suggest that an inverted U-shaped link occurs between renewable energy and environmental destruction, signifying renewable energy initially contributes to a diminution in environmental quality before subsequently improving it. Additionally, environmental quality is positively associated with natural resource rents and negatively associated with schooling, according to the findings. Furthermore, the findings reveal that schooling worsens the combined effect of renewable energy on environmental degradation. These conclusions are discussed in the paper.

Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension.

BACKGROUND: Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy. METHODS: A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed. RESULTS: A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p < 0.001). Right atrial pressure (8 mm Hg [5-10]; 5 mm Hg [3-8], p < 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p < 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N­terminal pro-B-type natriuretic peptide (r = -0.524, p < 0.001), tricuspid regurgitation velocity (r = -0.749, p < 0.001), right atrial area (r = -0.298, p = 0.037), and right atrial pressure (r = -0.463, p = 0.001). CONCLUSION: In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.

The relationship between hyperpolypharmacy and one-year outcomes in patients with critical limb ischemia undergoing below-knee endovascular therapy.

BACKGROUND: Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality. METHODS: A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using ≥10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacy. RESULTS: We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p<.001] and mortality [28 (42.4) versus 12 (9), p<.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality. CONCLUSION: Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI.

A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score.

OBJECTIVES: Treatment of abdominal aortic aneurysms (AAA) with endovascular aortic repair (EVAR) has become quite common in recent years. This method, which has many advantages compared to the open surgical procedure, also has some complications. One of these complications is acute kidney injury (AKI). ACEF (age, creatinine, and ejection fraction) score, which is gaining popularity, can be an easy-to-use and cost-effective method in detecting this condition that causes increased morbidity and mortality. We aimed to evaluate whether this ACEF score may predict a development of AKI in patients who underwent EVAR. METHODS: A total of 133 consecutive patients with AAA who underwent EVAR were analyzed. The primary endpoint of the study was the development of AKI. The best cut-off value for the ACEF score to predict the development of AKI was calculated and according to this value, the patients were divided into two groups as those with high ACEF scores and those with low ACEF scores. ACEF score was calculated by the formula of age/EF + 1 (if baseline creatinine > 2 mg/dL). RESULTS: After the exclusion criteria, a total of 118 patients were included in the study, and 20 (16.9%) of them developed AKI after EVAR. In the ROC curve analysis, a cut-off value of 1.34 was found for the ACEF score, and scores above this value were found to be independent predictors of AKI development after EVAR. In addition to the ACEF score, the contrast media volume was also found to be an independent predictor of the development of AKI. CONCLUSION: In conclusion, ACEF is a simple and effective scoring system in patients undergoing EVAR. To the best our knowledge, our study is the first study which applies ACEF score to predict AKI in EVAR patients.

C-reactive protein to albumin ratio provides important long-term prognostic information in patients undergoing endovascular abdominal aortic repair.

BACKGROUND: The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR). MATERIAL AND METHOD: We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality. RESULTS: 32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months' follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60-11.88) versus 1.63 (0.72-3.24), p < 0.001). Kaplan-Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354-5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282-6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899-35.320, p = 0.005) were the independent predictors of mortality. CONCLUSION: CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

Malnutrition provides important long-term prognostic information in patients undergoing endovascular abdominal aortic aneurysm repair.

OBJECTIVES: Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement. METHODS: We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality. RESULTS: During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0-4.0) vs 1.0 (0.0-2.0), p < 0.001) was higher when compared to survivor group. Kaplan-Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes. CONCLUSIONS: Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

Novel markers of ventricular repolarization are associated with mortality in patients undergoing surgical aortic valve replacement for severe aortic stenosis.

INTRODUCTION: Aortic stenosis (AS) is the most common degenerative valvular heart disease that can affect left ventricular functions. Tp-e interval and Tp-e/QT ratio is a novel repolarization marker which is associated with adverse cardiovascular events in several cardiovascular diseases. In our study, our aim is to investigate the prognostic effect of Tp-e interval, Tp-e/QT and Tp-e/QTc ratios on mortality in patients who underwent successful surgical aortic valve replacement (AVR). METHODS: A total of three hundred seventy-five patients undergoing successful surgical AVR were included in this study. Then, patients were divided into two groups according to mortality as group 1 without mortality (342 patients) and group 2 with mortality (33 patients). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were calculated for both groups. RESULTS: Tp-e interval (71 (63.7-77); 86 (84-88), p < .001), Tp-e/QT ratio (0.19 (0.17-0.20); 0.23 (0.22-0.23), p < .001) and Tp-e/QTc ratio (0.17 ± 0.02; 0.21 ± 0.01, p < .001) were higher in group 2 compared to group 1. In multivariate logistic regression analyses Tp-e interval (odds ratio [OR]: 1.315, 95% confidence interval [CI]: 1.203-1.437, p < .001), Tp-e/QT ratio (OR: 7.334, 95% CI: 3.274-1.643, p < .001) and Tp-e/QTc ratio (OR: 2.567, 95% CI: 4.106-1.605, p < .001) were found to be independent predictors of mortality. Additionally, a Kaplan-Meier survival analysis also revealed that long term survival was found to be significantly decreased in patients with higher Tp-e/QT ratio (Log-Rank p < .001) and Tp-e/QTc ratio (Log-Rank p < .001). CONCLUSION: Tp-e interval, Tp-e dispersion, Tp-e/QT, and Tp-e/QTc ratios are associated with worse prognosis after surgical AVR in patients with severe AS. All of them are also independent predictors of mortality.

The Relationship Between Obstructive Sleep Apnea and Coronary Plaque: A Coronary Computed Tomographic Angiography Study.

BACKGROUND: Coronary artery disease continues to be the most important cause of morbidity and mortality. Obstructive sleep apnea (OSA) is independently associated with subclinical atherosclerosis. In this study, we aimed to assess the relationship between the presence of coronary plaques and OSA and between coronary plaque burden and the severity of OSA according to plaque type. METHODS: In this cross-sectional study, we enrolled 214 consecutive patients who were divided into four groups of 43 patients (age: 52.3 ± 6.4 years) without OSA, 51 patients (age: 53.9 ± 6.7 years) with mild OSA, 40 patients (age: 55.2 ± 5.9 years) with moderate OSA, and 80 patients (age: 54.9 ± 7.2 years) with severe OSA according to the apnea-hypopnea index (AHI). We performed coronary computed tomographic angiography (CCTA) and evaluated plaque positivity, the presence of non-calcified/mixed plaques, and total stenosis score for each group. RESULTS: The prevalence of non-calcified/mixed plaques was three times higher in the severe OSA (41.3%) group and two times higher in the moderate OSA (30.0%) group compared to the patients without OSA (14.0%). When the four groups were examined in terms of plaque burden, the total stenosis score was found to increase with the presence and severity of OSA (0.27 ± 0.85, 1.07 ± 2.44, 1.75 ± 2.85, and 2.55 ± 3.96 respectively, p = 0.001). In addition, AHI and age were independent predictors of the presence of non-calcified/mixed plaques (p < 0.001 and p = 0.007, respectively). CONCLUSIONS: The presence of coronary artery plaques, especially non-calcified/mixed plaques, and coronary artery stenosis as measured by CCTA was significantly associated with the severity of sleep-disordered breathing in symptomatic patients at low to intermediate risk of coronary artery disease. Prospective studies are needed to establish the relationship between plaque burden and OSA.

Predictive value of a fragmented QRS complex in patients undergoing primary angioplasty for ST elevation myocardial infarction.

OBJECTIVES: The aim of this study was to evaluate the prognostic value of fragmented QRS (fQRS) on electrocardiography (ECG) patients with acute ST-segment elevation in myocardial infarction (STEMI), who are undergoing primary percutaneous coronary intervention (PCI). METHODS: We prospectively enrolled 414 consecutive STEMI patients (mean age of 55.2 ± 12.2 years old, range of 26-91-years old) undergoing primary PCI. The study patients were divided into two groups according to the presence or absence of fQRS as shown by ECG in the first 48 hours. The presence of fQRS group was defined as fQRS(+) (n = 91), and the absence of fQRS group was defined as the fQRS(-) (n = 323) group. Clinical characteristics and the one-year outcome of the primary PCI were analyzed. RESULTS: The patients in the fQRS(+) group were older (mean age 60.7 ± 12.5 vs. 53.6 ± 11.6 years old, P < 0.001). Higher one-year all-cause mortality rates were observed in the fQRS group upon ECG (23.1% vs. 2.5%, P < 0.001, respectively). When using the Cox multivariate analysis, the presence of fQRS on the ECG was found to be a powerful independent predictor of one-year all-cause mortality (hazard ratio: 5.24, 95% confidence interval: 1.43-19.2, P = 0.01). CONCLUSIONS: These results suggest that the presence of fQRS on ECG was associated with an increased in-hospital cardiovascular mortality, and one-year all-cause mortality in patients with STEMI who are under primary PCI.

Predictive Value of Elevated Uric Acid in Turkish Patients Undergoing Primary Angioplasty for ST Elevation Myocardial Infarction.

BACKGROUND: Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum UA levels have been correlated with all major forms of death from cardiovascular disease, including acute, subacute, and chronic forms of coronary artery disease (CAD), heart failure, and stroke. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of UA in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: We prospectively enrolled 434 consecutive Turkish STEMI patients (mean age 55.4 ± 12.4 years, 341 male, 93 female) undergoing primary PCI. The study population was divided into tertiles based on admission UA values. The high UA group (n = 143) was defined as a value in the third tertile (> 5.7 mg/dl), and the low UA group (n = 291) included those patients with a value in the lower two tertiles (≤ 5.7 mg/dl). Clinical characteristics, in-hospital and six-month outcomes of primary PCI were analyzed. RESULTS: Compared to the low UA group, only Killip class > 1 at admission was more prevalent in the high UA group (3.4% vs. 17.5%, p < 0.001, respectively). Higher in-hospital cardiovascular mortality and six-month all-cause mortality rates were observed in the high UA group than in the lower group (12.6% vs. 1.7%, respectively, p < 0.001) and (19.6% vs. 4.1%, respectively, p < 0.001). In Cox multivariate analysis; a high admission UA value (> 5.7 mg/dl) was found to be a powerful independent predictor of six-month all-cause mortality (hazard ratio: 5.57, 95% confidence interval: 1.903-16.3, p = 0.002). CONCLUSIONS: These results suggest that a high level of UA on admission was associated with increased in-hospital cardiovascular mortality, and six-month all-cause mortality in Turkish patients with STEMI undergoing primary PCI. KEY WORDS: Primary angioplasty; ST elevation myocardial infarction; Uric acid.

Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

OBJECTIVE: The aim of this study was to evaluate the prognostic value of mean platelet volume (MPV) in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: We prospectively enrolled 495 consecutive STEMI patients.The study population was divided into tertiles based on admission MPV values. The high MPV group (n= 148) was defined as a value in the third tertile (> 8.9), and the low MPV group (n = 347) included those patients with a value in the lower two tertiles (< or = 8.9). Clinical characteristics, in-hospital and six-month outcomes of primary PCI were analysed. RESULTS: Higher six-month all-cause mortality rates were observed in the high MPV group In Cox multivariate analysis; a high admission MPV value (> 8.9) was found to be a powerful independent predictor of six-month all-cause mortality. CONCLUSIONS: These results suggest that a high admission MPV level was associated with increased six-month all-cause mortality in patients with STEMI undergoing primary PCI.

The impact of energy security on environmental degradation: new evidence from developing countries.

This study investigates the energy security and income roles in testing environmental Kuznets curve (EKC) for developing countries from 1990 to 2019. The panel quantile regression approaches are employed to examine the relationship between the variables, considering that income and energy security effects on carbon emissions may vary across distributions. Findings revealed that the EKC hypothesis was inconsistent at low and high quantiles when estimating energy availability, affordability, and acceptability. The validity of inverted U-shaped EKC is supported at high quantiles for energy affordability and accessibility in developing countries. However, given the energy accessibility and acceptability, the EKC hypothesis becomes invalid in developing countries. Notably, developing countries have yet to progress toward achieving energy security as a switch component to low carbon emissions. This study contributes to the literature by revealing the effect of availability, accessibility, affordability, and acceptability of energy security on carbon dioxide emissions (CO2). Thus, it suggests implications for improving environmental quality in developing countries by enhancing energy security. Diversifying energy sources with nuclear, renewable, and developing technologies reduces dependence risks on a single source while improving efficiency through technology and demand management lowers carbon emissions and strengthens energy security. Beyond energy security, this study emphasises sustainable urban planning to promote compact development, effective transportation, and green infrastructure to reduce energy use and improve environmental sustainability, ultimately reducing carbon emissions.

The nexus between government spending, economic growth, and tourism under climate change: testing the CEM model for the USA.

This study examines the impact of government spending, income, and tourism consumption on CO2 emissions in the 50 US states through a novel theoretical model derived from the Armey Curve model and the Environmental Kuznets Curve hypothesis. The findings of this research are essential for policymakers to develop effective strategies for mitigating environmental pollution. Utilizing panel cointegration analysis, the study provides valuable insights into whether continued increases in government spending contribute to higher pollution levels. By identifying the threshold point of spending as a percentage of GDP, policymakers can make informed decisions to avoid the trade-off between increased spending and environmental degradation. For instance, the analysis reveals that Hawaii's tipping point is 16.40%. The empirical results underscore the importance of adopting sustainable policies that foster economic growth while minimizing environmental harm. These findings will aid policymakers in formulating targeted and efficient approaches to tackle climate change and promote long-term environmental sustainability in the United States. Moreover, the impact of tourism development on CO2 emissions varies across states, with some US states experiencing a decrease while others see an increase.

Are economic growth and environmental pollution a dilemma?

For the first time, this study introduces-proposes using the Armey curve hypothesis (ACH) for testing the environmental Kuznets curve hypothesis (EKCH) in the relevant literature. The rationale for this new proposed methodology is that both hypotheses are expected to have similar inverted U-shaped curves. Hence, we combine the aforementioned hypotheses to obtain a single composite model. This single model may allow us to calculate a maximum (optimum) level of government expenditures that will increase or decrease CO2 emissions for USMCA (the USA-Mexico-Canada Agreement) countries. To this end, our study employs an augmented mean group (AMG) estimator. The results demonstrate that the EKCH is verified by way of the AC model only for Mexico. Additionally, with the advantage of this approach, we calculated the optimal government spending level, which will increase both per capita real GDP (RGDPPC) and CO2 emissions in this country by around 26.4% of RGDPPC. This level of spending will be a kind of threshold point for the Mexican government's policymakers. Hence, they will know that if they continue to spend more than this level, both the RGDPPC and CO2 emissions will decrease, implying either a lower RGDPPC or a cleaner environment. The primary purpose of the proposed methodology in this study is to reveal the possible effects of the government's economic growth-oriented increased public expenditures on the environment in a single composite model. In other words, the relationship between economic growth and the environment is approached from the perspective of public spending, and it is reminded that governments should have harmonious and sustainable public spending policies for both economic growth and a cleaner environment.

A Novel Closed-Loop Balloon-Stent Embolization for the Treatment of Coronary Artery Perforation.

Coronary artery perforation is a serious and potentially life-threatening complication of percutaneous coronary intervention. Although there are a few treatment options available, such as coil or fat tissue embolization and stent-graft implantation, the closed-loop balloon-stent technique can be especially effective for thin vessel ruptures. In this case report, we demonstrate the successful application of the closed-loop balloon-stent embolization for a perforation of the distal left anterior descending artery, a procedure which, to our knowledge, has not been previously documented in the literature.

The resilience of green firms in the twirl of COVID-19: Evidence from S&P500 Carbon Efficiency Index with a Fourier approach.

This paper investigates the resilience of environmentally friendly companies in an overwhelming economic and social environment that has been generated after the outbreak of the novel coronavirus disease (COVID-19) pandemic. To this respect, we have investigated the cointegration between the Standard & Poor's (S&P) 500 Carbon Efficiency Index (CEI) with COVID-19 cases, supplemented with covariates such as government response stringency to the pandemic, economic policy uncertainty, oil prices and global markets fluctuations. We have used daily data from 2nd January to 5th October 2020 and have employed a robust estimator within a Fourier approach to accommodate both sharp and smooth breaks. Our results suggest that green companies have been positively affected by the outbreak of COVID-19. Our paper provides practical implications for companies that wish to furnish themselves with resilience during rough times and stakeholders who wish to invest in safe, long-lasting returns.

Renewable energy-economic growth nexus revisited for the USA: do different approaches for modeling structural breaks lead to different findings?

It can be observed from the existing energy literature the previous papers investigating the influence of renewables consumption on GDP for the USA commonly ignore structural breaks in the US economy. Hence, the purpose of this paper is to examine the impact of renewable energy consumption on economic growth for the USA using quarterly data over the period 1977Q1-2019Q3 through unit root and cointegration methods based on different approaches in modelling structural breaks. Our empirical evidence confirms that all unit root tests give similar outputs and show all the variables become stationary at 1st differences. Besides, cointegration tests show highly different results in terms of the statistical significance of the coefficients. For instance, the cointegration test without structural breaks indicates that renewable energy consumption has no impact on economic growth. With sharp structural breaks in the cointegration approach, there is no cointegration between the variables. The empirical findings of the cointegration test with sharp and gradual breaks imply that renewable energy consumption has positive effects on economic growth. This paper discusses the implications of the empirical findings.

Is there a trade-off between financing current account deficits and environmental deterioration in developing countries? An empirical investigation for the validity of the pollution haven hypothesis.

The impact of foreign direct investment (FDI) on environmental quality has been discussed in the environmental economics literature over the last decades. Within this scope, the pollution haven hypothesis (PHH) postulates that FDI inflows can cause environmental degradation in developing countries. Using data over the period 1993-2018 for 10 developing countries with current account deficits, this paper aims to test the validity of the PHH. Therefore, the paper examines whether or not developing countries face off a trade-off between financing current account deficits and environmental deterioration. The paper employs panel data methods that consider cross-sectional dependence. The empirical findings show that foreign direct investment inflows have no impact on environment, meaning the PHH does not dominate for these countries. Hence, the findings indicate that there is no trade-off between financing current account deficits and environmental deterioration.

The Predictive Value of CHA2DS2-VASc Score on Residual Syntax Score in Patients With ST Segment Elevation Myocardial Infarction. / O Valor Preditivo do Escore CHA2DS2-VASc no Escore Syntax Residual em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST.

BACKGROUND: The CHA2DS2-VASc score is associated with adverse clinical outcomes in patients with cardiovascular disease. The residual Syntax score (rSS) is a scoring tool which has prognostic value in patients with ST segment elevation myocardial infarction (STEMI). OBJECTIVES: Our aim in this study is to investigate the predictive value of the CHA2DS2-VASc score on rSS in STEMI patients. METHODS: A total of 688 consecutive patients with STEMI undergoing percutaneous coronary intervention were evaluated. Baseline demographic and clinical variables besides the CHA2DS2-VASc score were assessed. The patients were divided into two groups; patients with rSS of 8 or below as group 1 (509 patients) and more than 8 as group 2 (179 patients). A p-value < 0.05 was considered statistically significant. RESULTS: The CHA2DS2-VASc score was higher in group 2 [1 (0-2); 1 (1-3), p<0.001] compared to group 1. The incidence of hypertension [151 (29.7%); 73 (40.8%), p=0.006], patients ≥75 years [18 (3.5%); 21 (11.7%), p<0.001], diabetes mellitus [85 (16.7%); 50 (27.9%), p=0.001] and vascular disease [12 (2.4%); 11 (6.1%), p=0.029] were higher in group 2. In multivariate logistic regression analysis, the CHA2DS2-VASc score (OR=1.355; 95%CI=1.171-1.568; p<0.001), age ≥75 years [OR=3.218; 95%CI=1.645-6.295; p=0.001] and diabetes mellitus [OR=1.670; 95%CI=1.091-2.557; p=0.018] were independent predictors of high rSS. The receiver-operating characteristic curve analysis demonstrated that the CHA2DS2-VASc score had good predictive value for high rSS with a cut-off value of 1.5 (area under curve (AUC): 0.611, 95% confidence interval (CI):0.562-0.659, p<0.001). CONCLUSIONS: The CHA2DS2-VASc score has a predictive value on rSS in patients with STEMI. The CHA2DS2-VASc score was also an independent predictor of higher rSS.

FUNDAMENTO: O escore CHA2DS2-VASc está associado a desfechos clínicos adversos em pacientes com doença cardiovascular. O escore Syntax residual (residual Syntax score ­ rSS) é uma ferramenta de pontuação que tem valor prognóstico em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). OBJETIVOS: Este estudo objetivou investigar o valor preditivo do escore CHA2DS2-VASc para o rSS em pacientes com IAMCSST. MÉTODOS: Foram avaliados 688 pacientes consecutivos com IAMCSST submetidos à intervenção coronária percutânea. Além do escore CHA2DS2-VASc, variáveis demográficas e clínicas de referência foram analisadas. Os pacientes foram divididos em dois grupos: grupo 1 ­ indivíduos com rSS até 8 (509 pacientes); grupo 2 ­ aqueles com rSS acima de 8 (179 pacientes). Valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: O escore CHA2DS2-VASc foi maior no grupo 2 [1 (0­2); 1 (1­3), p<0,001] comparado ao grupo 1. A incidência de hipertensão [151 (29,7%); 73 (40,8%), p=0,006], idade ≥75 anos [18 (3,5%); 21 (11,7%), p<0,001], diabetes mellitus [85 (16,7%); 50 (27,9%), p=0,001] e doença vascular [12 (2,4%); 11 (6,1%), p=0,029] foi maior no grupo 2. Na análise de regressão logística multivariada, o escore CHA2DS2-VASc (odds ratio ­ OR=1,355; intervalo de confiança de 95% ­ IC95%=1,171­1,568; p<0,001), idade ≥75 anos [OR=3,218; IC95%=1,645­6,295; p=0,001] e diabetes mellitus [OR=1,670; IC95%=1,091­2,557; p=0,018] foram preditores independentes de rSS elevado. A análise da curva receiver-operating characteristic demonstrou o bom valor preditivo do escore CHA2DS2-VASc para rSS elevado com valor de corte de 1,5 (área sob a curva/area under the curve ­ AUC= 0,611, IC95%=0,562­0,659, p<0,001). CONCLUSÕES: O escore CHA2DS2-VASc tem valor preditivo para rSS em pacientes com IAMCSST. Além disso, o escore CHA2DS2-VASc foi um preditor independente de rSS mais alto.