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CT as Accurate as Angiography in Detecting Coronary Artery Disease Non-Invasively

By MedImaging International staff writers
Posted on 07 Mar 2022

Image: CT confirms CAD in patient with atypical chest pain. (Photo courtesy of Charité-Universitätsmedizin Berlin)

A study by researchers from 31 European clinical institutions suggests that cardiac computed tomography (CT) offers a similar level of diagnostic accuracy as catheterization in patients with suspected coronary artery disease (CAD), in addition to being associated with a lower risk of complications.

The study, led by researchers at Charité-Universitätsmedizin Berlin (Berlin, Germany), was a part of the DISCHARGE trial and aimed to test cardiac CT as a non-invasive alternative to catheterization, the current standard diagnostic test for intermediate-risk patients. CAD is common across the globe and is one of the leading causes of death in developed countries and aging populations. The disease is associated with impaired blood flow in the coronary arteries, i.e., the arteries which supply oxygen to the heart. Chest pain, shortness of breath and fatigue with activity can all be indicators of either chronic or acute disease, both of which are associated with an increased risk of heart attack, stroke and even cardiovascular death - examples of what are referred to ‘major adverse cardiovascular events’. Symptoms of CAD are caused by deposits inside the artery walls which build up over many years.

The current standard diagnostic test for coronary artery disease is a minimally invasive procedure known as coronary angiography (or cardiac catheterization). This test shows if the coronary arteries supply a sufficient amount of blood or whether blood flow is impaired by arterial narrowing. Any narrowing detected in this manner can be treated during the procedure itself, through the use of small, inflatable balloons and extremely thin mesh tubes known as stents, which are used to prop open the newly widened blood vessels. More than 3.5 million of these procedures are carried out in European catheterization laboratories (or cath labs) every year, and numbers continue to increase. Approximately two million – i.e., significantly more than half – of these minimally invasive procedures do not involve immediate treatment in the cath lab. In these cases, the procedure is able to rule out narrowed or blocked coronary arteries.

The main question addressed by the DISCHARGE trial was whether the low-risk, non-invasive coronary CT method can provide a safe alternative to catheterization in certain patients with suspected CAD. In order to test the effectiveness of both of these diagnostic imaging techniques in patients with stable chest pain, the project followed more than 3,500 patients for a duration of four years. Using a process known as randomization, patients were assigned by chance to either computed tomography or cardiac catheterization. If their initial evaluation ruled out obstructive coronary artery disease, participants were discharged back to their referring physician for further treatment – a step which gave the trial its name: DISCHARGE. Patients who were diagnosed as having the disease were managed in accordance with European guidelines at the time of the study.

For their overall analysis, the researchers also included criteria such as improvements in chest pain and quality of life over the course of the trial. By helping to reduce the large number of catheterization procedures being performed, this new strategy could also help relieve pressure on health care systems. The Federal Joint Committee (G-BA) has initiated a formal assessment to evaluate the benefits of cardiac CT. As a next step, the trial’s method for estimating a person’s clinical risk of having coronary artery disease will need to be further evaluated to determine whether it can help to improve routine care.

“The trial confirmed that a CT-based management is safe in patients with stable (i.e., non-acute) chest pain and suspected coronary artery disease,” said Prof. Dr. Marc Dewey, Vice Chair of the Department of Radiology on Campus Charité Mitte. “Among the patients referred for cardiac catheterization and included in this trial, the risk of major adverse cardiovascular events was found to be similar in both the CT and catheterization groups, occurring in 2.1% and 3.0% of patients, respectively. The incidence of major procedure-related complications was found to be four-times lower in patients managed with an initial CT strategy.”

“CT may represent a safe alternative to cardiac catheterization in specific patients. In patients with a low risk of CAD diagnosis, CT can help prevent an unnecessary catheterization procedure,” said Prof. Dr. Henryk Dreger, Deputy Head of Charité’s Department of Cardiology and Angiology, who was responsible for monitoring the catheterization lab procedures performed at Charité. “Now that CT has been standardized and quality-tested as part of the DISCHARGE trial, this method could be made more widely available as part of the routine clinical care of people with intermediate CAD risk.”

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Charité-Universitätsmedizin Berlin

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57 (100.85105895996): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (580.0724029541): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 6010.0555419922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

60 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

61 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

62 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

63 (99.897384643555): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (374.79400634766): SELECT fid FROM jos_deeppockets WHERE id=294791875 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791875 AND published='1' LIMIT 1

65 (206.94732666016): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

66 (49.829483032227): select jos_twitters.link from jos_twitters where cat=10

67 (27.179718017578): select jos_facebook.link from jos_facebook where cat=10

68 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

69 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

70 (30.040740966797): SELECT fid FROM jos_deeppockets WHERE id=294791875 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791875 AND published='1' LIMIT 1

71 (29.802322387695): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

72 (141.85905456543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (123.02398681641): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (36.954879760742): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (81.777572631836): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (34.809112548828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (31.948089599609): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

107 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

108 (62.942504882812): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (295.87745666504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

111 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

112 (344.99168395996): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (298.97689819336): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (150.91896057129): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791871 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (320.1961517334): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791871 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (593.18542480469): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (371.93298339844): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

119 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

120 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

121 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

122 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

123 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

124 (330.92498779297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 32056.093215942): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (166.89300537109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

127 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

128 (!!!!! 3504.0378570557): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791875 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791875 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 766328.81164551): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (103.95050048828): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (436.06758117676): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (!!!!! 1963.1385803223): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (66.995620727539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (176.90658569336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (432.96813964844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (393.15223693848): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (214.0998840332): SELECT name FROM jos_deeppockets WHERE id=215

140 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=215

141 (448.94218444824): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (431.06079101562): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

144 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

145 (!!!!! 8811.9506835938): TRUNCATE TABLE jos_trademed_module

146 (147.10426330566): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (75.101852416992): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791875 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (441.07437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

151 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

152 (!!!!! 1021.146774292): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

154 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

155 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791875 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791875 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (418.90144348145): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

157 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

158 (36.001205444336): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (317.81196594238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

160 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791875 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791875 AND published='1' LIMIT 1

161 (149.01161193848): select jos_twitters.link from jos_twitters where cat=10

162 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

163 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

164 (38.14697265625): select jos_linkedin.link from jos_linkedin where cat=10

165 (260.1146697998): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1219.0341949463): insert into jos_banners_delta values (14615,'2025-05-02 14:36:13','52.14.184.10','view'),(14202,'2025-05-02 14:36:13','52.14.184.10','view'),(14203,'2025-05-02 14:36:13','52.14.184.10','view')

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