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Combining Calcium Scoring and SPECT Imaging Evaluates Patients' Heart Risk Better

By MedImaging International staff writers
Posted on 24 Nov 2009

By relying solely on a patient's clinical risk profile or the results of one imaging test when assessing patients with chest pain, clinicians may be missing significant, early signs of atherosclerotic disease and opportunities to intervene, according to new findings.

The study's results were published in the November 10, 2009, issue of the Journal of the American College of Cardiology (JACC). The authors recommend adding coronary artery calcium score (CACS) testing in patients with a normal single-photon emission computed tomography (SPECT) scan to better identify those at high long-term risk for cardiac events, in whom an earlier focus on aggressive risk factor modification and other medical therapies may be beneficial.

"Typically, when a patient presents with chest pain and the [SPECT] test result is normal, we tell them everything looks fine, but this may not be the case,” said John Mahmarian, M.D., a cardiologists from the Methodist DeBakey Heart and Vascular Center (Houston, TX, USA), and lead investigator of the study. "If a large extent of calcium is present in the coronary arteries, which can't be measured by functional SPECT imaging, he or she is at high long-term risk for a cardiac event. Based on our findings, using both tests to define risk is better than either test alone.”

The study--the first to be conducted over such a long duration--found that approximately half of all patients with a normal SPECT result had a CACS of at least moderate severity, signaling cardiac risk that would not otherwise have been predicted. Increasing CACS severity is associated with a greater likelihood of cardiac events and deaths. Disturbingly, the risk of death or a heart attack over time increased by three-fold when the calcium score was severe in patients with a normal SPECT. CACS was also found to be a stronger predictor of cardiac events than diabetes, which is considered synonymous with having coronary artery disease.

For this reason, the researchers urge CACS be performed in patients with a normal SPECT who have an intermediate or high clinical risk factor profile for coronary artery disease (e.g., smoking, high cholesterol, high blood pressure, diabetes, family history). If CACS is high, patients should be treated aggressively to prevent the progression of disease, added Dr. Mahmarian.

"Although a normal SPECT result predicts excellent short-term event-free survival, it doesn't tell us anything about long-term risk, and long-term outcome is significantly worse if the CACS is severe,” said Dr. Mahmarian. "By integrating these two tests, we can identify patients at high long-term risk for heart problems and may, thereby, have a better shot at preventing further development of obstructive disease and improving outcomes.”

Investigators followed 1,126 asymptomatic patients without a previous history of coronary artery disease who had a CACS and stress SPECT scan performed within a close period of time (median of 56 days). The study period was from December 1995 to May 2006. "Our results reinforce the need to press forward and look at how an integrated approach to imaging can be cost-effective in preventing downstream events and improving outcomes,” said Dr. Mahmarian.

The investigators reported that the next step is to conduct prospective trials to evaluate how adding CACS to functional SPECT scans can guide the intensity of therapy targeted to individual patients and whether such an approach can improve outcome in a cost-effective manner.

A functional SPECT test is used to assess how blood flows to the heart. A normal SPECT result generally defines a group with a < 1% annual risk of cardiac death and/or nonfatal heart attack, which increases to approximately 6% if the study result is abnormal.

CACS can detect varying degrees of blockages in the heart before the development of stress-induced myocardial ischemia, a painful heart condition caused by lack of blood flow to the heart.

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60 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

61 (!!!!! 5342.960357666): 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

62 (500.20217895508): SELECT fid FROM jos_deeppockets WHERE id=294726551 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726551 AND published='1' LIMIT 1

63 (245.80955505371): 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=213 ORDER BY `ordering`

64 (123.02398681641): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

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

68 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294726551 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726551 AND published='1' LIMIT 1

69 (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=213 ORDER BY `ordering`

70 (200.98686218262): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (172.85346984863): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (90.122222900391): 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`

73 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (49.114227294922): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (40.054321289062): 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`

90 (92.983245849609): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (72.956085205078): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (871.89674377441): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (88.930130004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (145.91217041016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

105 (!!!!! 4853.9638519287): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

106 (83.92333984375): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (80.82389831543): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

109 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

110 (46.014785766602): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (524.99771118164): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (660.89630126953): 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

113 (345.94535827637): 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

114 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

115 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

116 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

117 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

118 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

119 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

120 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

122 (278.94973754883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 57658.195495605): 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

124 (622.03407287598): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726551 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726551 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 16162.872314453): ( 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

126 (66.995620727539): ( 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

127 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (32.186508178711): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (437.97492980957): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (47.206878662109): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (675.91667175293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (545.97854614258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (451.80320739746): SELECT name FROM jos_deeppockets WHERE id=213

138 (!!!!! 3669.0235137939): SELECT name FROM jos_deeppockets WHERE id=213

139 (777.9598236084): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (496.86431884766): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1181.1256408691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

142 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

143 (!!!!! 18155.097961426): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3858.0894470215): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (766.99256896973): 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=294726551 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (502.10952758789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

149 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

150 (!!!!! 1461.9827270508): 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

151 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

152 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

153 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726551 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726551 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2267.8375244141): 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=213 or channel_id is null)

155 (88.930130004883): 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=213 or channel_id is null)

156 (51.021575927734): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

158 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726551 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726551 AND published='1' LIMIT 1

159 (69.856643676758): select jos_twitters.link from jos_twitters where cat=10

160 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

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