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30-Day Risk for Patients with Chest Pain Effectively Predicted by CT Angiography

By MedImaging International staff writers
Posted on 12 Apr 2012

Coronary computed tomography angiography (CCTA) can rapidly and effectively determine which patients complaining of chest pain at an emergency department (ED) can safely be sent home.

These findings were presented in March 2012 at the American College of Cardiology’s 61st annual scientific session, held in Chicago (IL, USA). Of the 6 million annual visits to US emergency departments (EDs) for chest pain, up to 85% are not actually caused by heart problems. A lot of progress has been made in identifying high-risk patients, but low-risk patients pose evaluation challenges that can be expensive in risk, discomfort, and recovery time for the patient and in healthcare resources. Most of these patients are admitted for standard “rule-out” care that typically requires a hospital stay of about 24 hours and a stress test, with or without imaging. If findings are positive, the next step is likely to be cardiac catheterization, an invasive and time-consuming procedure that involves threading a thin tube into the heart.

ED physicians have a standard for discharging a person with chest pain: less than 1% risk of heart attack or heart-related death over the next 30 days. For patients with no known heart disease, the major factor in considering that risk is whether any heart arteries show blockage of 50% or more. Cardiac catheterization is a conventional imaging technique used for this purpose.

“When EDs are crowded, all patients suffer,” said Harold I. Litt, MD, PhD, chief of cardiovascular imaging in the department of radiology at the Perelman School of Medicine, University of Pennsylvania (Philadelphia, USA) and the study’s lead investigator. “Our primary goal was to power the study statistically to prove the safety of CCTA so that ED physicians could feel comfortable sending home patients who have negative results from CCTA scans, and we did that.”

ACRIN PA 4005 is the first cardiovascular study conducted by the American College of Radiology Imaging Network (ACRIN). In this phase-4 trial, 1,393 patients at five centers were randomly assigned to conventional rule-out care or CCTA in a 1:2 ratio. Healthcare providers at each site made all decisions about tests and treatment for the traditional care group patients on an individual basis. The CCTA group followed a three-part protocol: (1) tests to measure blood levels of two substances associated with heart damage and risk of heart attack or stroke, (2) CCTA, and (3) discharge if test results were negative.

None of the 640 patients with a negative CCTA had a heart attack or died within 30 days after discharge (30-day event rate of < 1%). These findings apply to patients at low-to-intermediate risk. People who have a known history of heart disease require a much more comprehensive evaluation before they can be sent home safely, Dr. Litt emphasized.

The study also showed that CCTA was a better indicator than stress tests of finding patients with coronary artery disease (9% vs 3%). “Stress tests are positive only when there’s enough blockage to impair blood flow,” Dr. Litt said. “CCTA lets you actually see atherosclerosis and stenosis, even if that’s not what’s causing your chest pain that day.”

Lastly, the trial revealed distinct advantages for CCTA compared with traditional care in several categories of resource use: number of patients discharged rather than admitted to the hospital (50% vs. 23%), median length of stay (18 hours vs. 25 hours) and median length of stay for patients who had a negative CCTA or stress test (12 hours vs. 25 hours).

Researchers will be collecting data regarding costs associated with these findings and talking with both groups to analyze 30-day and one-year utilization and cost-effectiveness. In-hospital and 30-day cost data are expected within six months. Researchers also recorded data about arterial plaque that will be analyzed in the future.

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Perelman School of Medicine, University of Pennsylvania

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60 (!!!!! 1453.8764953613): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

61 (!!!!! 12525.796890259): 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 (!!!!! 2827.1675109863): SELECT fid FROM jos_deeppockets WHERE id=294740177 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740177 AND published='1' LIMIT 1

63 (!!!!! 4937.8871917725): 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 (!!!!! 7648.9448547363): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 7966.0415649414): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 3921.0319519043): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7960.0811004639): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 7784.1281890869): SELECT fid FROM jos_deeppockets WHERE id=294740177 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740177 AND published='1' LIMIT 1

69 (!!!!! 7928.1330108643): 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 (!!!!! 7725.9540557861): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 5891.0846710205): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 2300.0240325928): 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 (527.14347839355): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (213.8614654541): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (151.15737915039): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 2125.9784698486): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (122.7855682373): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (271.79718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (202.17895507812): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (247.00164794922): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 2813.1008148193): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (723.12355041504): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (73.19450378418): 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 (543.11752319336): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (213.8614654541): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (194.07272338867): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (133.99124145508): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (173.09188842773): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 6242.9904937744): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

105 (!!!!! 3676.8913269043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

106 (374.07875061035): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (483.03604125977): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3827.0950317383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

109 (200.98686218262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

110 (202.17895507812): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (729.08401489258): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 2541.7804718018): 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 (!!!!! 4613.8763427734): 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 (553.13110351562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

116 (689.02969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

117 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

118 (936.98501586914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

119 (656.8431854248): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

120 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

121 (184.05914306641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

122 (197.8874206543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 52118.062973022): 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 (!!!!! 1199.9607086182): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740177 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740177 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (46.014785766602): ( 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 (36.954879760742): ( 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 (730.99136352539): 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 (131.84547424316): 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 (!!!!! 1805.0670623779): 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 (99.897384643555): 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 (103.95050048828): 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 (79.870223999023): 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 (594.13909912109): 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 (57.93571472168): 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 (!!!!! 4690.8855438232): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (517.84515380859): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (126.12342834473): SELECT name FROM jos_deeppockets WHERE id=211

138 (77.962875366211): SELECT name FROM jos_deeppockets WHERE id=211

139 (940.08445739746): 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 (608.20579528809): 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 (681.87713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

142 (221.96769714355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

143 (!!!!! 14332.056045532): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4949.0928649902): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (957.01217651367): 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=294740177 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2710.1039886475): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (129.93812561035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (503.0632019043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

149 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

150 (!!!!! 3007.173538208): 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 (!!!!! 1063.1084442139): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

152 (!!!!! 3458.9767456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

153 (!!!!! 3345.9663391113): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740177 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740177 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 3913.8793945312): 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 (81.062316894531): 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 (195.02639770508): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 6530.0464630127): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

158 (!!!!! 7889.986038208): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740177 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740177 AND published='1' LIMIT 1

159 (!!!!! 6350.9941101074): select jos_twitters.link from jos_twitters where cat=10

160 (92.029571533203): select jos_facebook.link from jos_facebook where cat=10

161 (175.95291137695): select jos_google_plus.link from jos_google_plus where cat=10

162 (303.98368835449): select jos_linkedin.link from jos_linkedin where cat=10

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