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Long-Term Study Confirms CTA Effective for Chest Pain Diagnosis

By MedImaging International staff writers
Posted on 09 Jun 2009

The first long-term study tracking a large number of chest pain patients who are screened with coronary computed tomographic angiography (CTA) validates that the test is a safe, effective way to rule out serious cardiovascular disease in patients who come to hospital emergency rooms with chest pain, according to new research.

Chest pain is a common and expensive health complaint in the United States, bringing eight million people in the United States alone to hospital emergency departments each year. Although just 5 to 15% of those patients are found to be suffering from heart attacks or other cardiac diseases, more than half are admitted to the hospital for observation and additional testing. CTA streamlines the process and provides a faster and less expensive way to assess which patients have an acute coronary syndrome that require treatment.

"The ability to rapidly determine that there is nothing seriously wrong allows us to provide reassurance to the patient and to help reduce crowding in the emergency department [ED],” remarked lead author Judd Hollander, M.D., professor and clinical research director in the University of Pennsylvania School of Medicine (Penn; Philadelphia, USA) department of emergency medicine. "The use of this test is a win-win.”

Among patients enrolled in the trial after getting a negative scan (a scan showing no evidence of dangerous blockages in the coronary arteries) no patients in the study had heart attacks or required bypass surgery or placement of cardiac stents in the year following their test. The investigators reported that the findings provide a blueprint for how to appropriately and cost-effectively use this advanced imaging technology, which generates lifelike, three-dimensional photos of the heart and the matrix of blood vessels that surround it.

Investigators followed 481 patients who received negative CTA scans for one year after their hospital visit. The patients studied had an average age of 46. While 11% of patients were readmitted to the hospital and 11% received additional cardiac testing--stress tests or cardiac catheterizations--over the following year, none had heart attacks or needed revascularization procedures to prop open blocked coronary arteries. One patient in the study died of an unrelated cause during the year.

Previous Penn research has shown that CTA is both a faster and less expensive way to screen low-risk chest pain patients than conventional testing methods. Costs for patients who receive immediate CTA in the emergency department average approximately US$1,500, while costs for patients admitted to the hospital for stress testing and telemetry monitoring total more than $4,000 for each patient. Those studies also revealed that CTA helps get patients home faster, since patients who received immediate CTA were discharged after an average of eight hours, compared to stays that exceeded 24 hours for those who were admitted for scheduled testing and monitoring.

In spite of the increasing evidence that CTA provides cost savings, it remains unclear whether U.S. Medicare or any individual insurer will cover the tests in an emergency department setting. A ruling from the U.S. Centers for Medicare and Medicaid Services in the spring of 2008 laid out a specific, narrow set of circumstances under which coronary CTA costs would be reimbursed, but some physicians are continuing to petition for a reexamination of the issue given the increasing pressure to cut healthcare costs and increase emergency department efficiency.

"The evidence now clearly shows that when used in appropriate patients in the ED, we can safely and rapidly reduce hospital admission and save money,” Dr. Hollander stated. "It seems time to make a national coverage decision that will facilitate coronary CTA in the emergency department.”

The study's findings were presented May 15, 2009, at the Society for Academic Emergency Medicine's annual conference, held in New Orleans, LA, USA.

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62 (!!!!! 5718.9464569092): SELECT fid FROM jos_deeppockets WHERE id=294723489 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723489 AND published='1' LIMIT 1

63 (!!!!! 2741.0984039307): 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=211 ORDER BY `ordering`

64 (!!!!! 4843.9502716064): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 1620.0542449951): select jos_facebook.link from jos_facebook where cat=10

66 (699.99694824219): select jos_google_plus.link from jos_google_plus where cat=10

67 (167.8466796875): select jos_linkedin.link from jos_linkedin where cat=10

68 (928.87878417969): SELECT fid FROM jos_deeppockets WHERE id=294723489 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723489 AND published='1' LIMIT 1

69 (190.97328186035): 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=211 ORDER BY `ordering`

70 (!!!!! 1470.8042144775): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (286.10229492188): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (850.91590881348): 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 (!!!!! 2356.7676544189): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (261.06834411621): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (205.99365234375): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 1817.9416656494): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (72.956085205078): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (259.8762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (159.97886657715): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (184.05914306641): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (874.04251098633): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (241.04118347168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (85.115432739258): 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 (!!!!! 1025.915145874): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (180.95970153809): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (252.96211242676): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (146.86584472656): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (285.86387634277): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (328.06396484375): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (187.15858459473): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (156.87942504883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 3618.9556121826): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (359.05838012695): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (241.04118347168): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2567.0528411865): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

105 (198.1258392334): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

106 (355.00526428223): 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1332.0446014404): 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1885.8909606934): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

109 (317.09671020508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

110 (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 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1170.1583862305): 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (851.15432739258): 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 (771.99935913086): 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 (535.01129150391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

115 (277.99606323242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

116 (!!!!! 1039.0281677246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

117 (252.00843811035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

118 (781.05926513672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

119 (249.86267089844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

120 (759.84001159668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

121 (356.91261291504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

122 (715.01731872559): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 50163.984298706): 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 (!!!!! 1044.9886322021): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723489 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723489 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (63.180923461914): ( 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 (47.922134399414): ( 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 (323.05717468262): 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 (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

129 (268.93615722656): 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 (!!!!! 1278.1620025635): 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 (56.982040405273): 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 (41.007995605469): 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 (262.97569274902): 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 (48.160552978516): 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 (!!!!! 3407.0014953613): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (565.0520324707): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (71.048736572266): SELECT name FROM jos_deeppockets WHERE id=211

138 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

139 (849.00856018066): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 2238.9888763428): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (313.04359436035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

142 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

143 (!!!!! 15692.949295044): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4496.0975646973): 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (525.95138549805): 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=294723489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2127.1705627441): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (392.91381835938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (363.11149597168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

149 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

150 (!!!!! 3908.8726043701): 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 (!!!!! 2195.8351135254): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

152 (!!!!! 5603.0750274658): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

153 (!!!!! 1538.0382537842): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723489 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723489 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (404.83474731445): 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=211 or channel_id is null)

155 (59.127807617188): 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=211 or channel_id is null)

156 (340.93856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (165.22407531738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

158 (288.00964355469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723489 AND published='1' LIMIT 1

159 (!!!!! 4284.8587036133): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 7116.0793304443): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 7926.9409179688): select jos_google_plus.link from jos_google_plus where cat=10

162 (!!!!! 2605.9150695801): select jos_linkedin.link from jos_linkedin where cat=10

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