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Predicting Heart Attack Risk with CT Angiography

By MedImaging International staff writers
Posted on 25 Feb 2013

Coronary computed tomography angiography (CCTA) is an effective tool for determining the risk of myocardial infarctions and other abnormal cardiac events in patients with suspected coronary artery disease (CAD) but no treatable risk factors, such as high blood pressure or high cholesterol.

“CCTA should be considered as an appropriate first-line test for patients with atypical chest pain and suspected but not confirmed coronary artery disease,” said the study’s lead author, Jonathon Leipsic, MD, FRCPC, from the University of British Columbia (Vancouver, BC, Canada).

Treatment for heart disease typically involves tackling modifiable cardiovascular risk factors such as high blood pressure, elevated cholesterol, diabetes, and smoking. However, some risk factors, such as family history, are not modifiable, and no risk models exist to help guide clinicians to identify those symptomatic patients without cardiac risk factors who are at an increased risk of death and myocardial infarction. “This scenario, where patients are symptomatic but have no cardiac risk factors, comes up often in clinical practice,” Dr. Leipsic said. “We lack a good tool to stratify these patients into risk groups.”

CCTA is a noninvasive test that has shown high accuracy for the diagnosis or exclusion of coronary artery disease in individuals. However, referral for patients with suspected coronary artery disease is frequently based on clinical risk factor scoring. Less is known about the prognostic benefits of CCTA in individuals with no medically modifiable risk factors.

In the first study of its sort, published online February 2013 in the journal Radiology, Dr. Leipsic and colleagues correlated CCTA results with the risk of major adverse cardiac events in 5,262 patients with suspected coronary artery disease but no medically modifiable risk factors. They culled the data from the Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter (CONFIRM) registry.

After a median follow-up of 2.3 years, 104 patients had experienced a major adverse cardiovascular event. The researchers identified a high occurrence of CAD in the study group, in spite of the lack of modifiable risk factors. More than 25% of the patients had non-obstructive disease or disease related to the accumulation of plaque in the arteries, and another 12% had obstructive disease with a greater than 50% narrowing in a coronary artery. “We found that patients with narrowing of the coronary arteries on CT had a much higher risk of an adverse cardiac event,” Dr. Leipsic said. “This was true even for those without a family history of heart disease.”

Both asymptomatic and symptomatic patients with obstructive disease faced an increased risk for a major cardiac event. Contrarily, the absence of CAD on CCTA was associated with a very low risk of a major event.

The findings, according to the investigators, emphasize the need for improvement in the evaluation of individuals who may be overlooked by conventional techniques of CAD assessment. “If a patient shows up with vague symptoms and no medically modifiable risk factors, doctors often dismiss them or do a treadmill test, which won’t identify atherosclerosis and only has a modest sensitivity for detecting obstructive disease,” Dr. Leipsic said.

CCTA could help address this problem, Dr. Leipsic added, by helping to detect or rule out coronary artery disease and identifying those who may be helped with more intensive therapy. The researchers continue to examine the CONFIRM data with the goal of further clarifying the association between plaque and myocardial infarctions and the longer-term outlook for patients with coronary artery disease.

“We are now collecting data to determine the prognostic value of CCTA after five years or more of follow-up, which will be very important for the field,” Dr. Leipsic stated.

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61 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

62 (733.85238647461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

63 (271.08192443848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

64 (!!!!! 3443.9563751221): 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

65 (!!!!! 4092.9317474365): SELECT fid FROM jos_deeppockets WHERE id=294744917 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744917 AND published='1' LIMIT 1

66 (94.175338745117): 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`

67 (!!!!! 1322.9846954346): select jos_twitters.link from jos_twitters where cat=10

68 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10

69 (196.93374633789): select jos_google_plus.link from jos_google_plus where cat=10

70 (66.995620727539): select jos_linkedin.link from jos_linkedin where cat=10

71 (788.92707824707): SELECT fid FROM jos_deeppockets WHERE id=294744917 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744917 AND published='1' LIMIT 1

72 (247.95532226562): 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`

73 (!!!!! 1085.9966278076): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (483.98971557617): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (185.01281738281): 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`

76 (!!!!! 1061.9163513184): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (270.12825012207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (99.897384643555): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (241.99485778809): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (293.01643371582): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (879.04930114746): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (277.04238891602): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (226.97448730469): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (!!!!! 3711.2236022949): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (!!!!! 4451.0364532471): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (60.796737670898): 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`

93 (!!!!! 3895.0443267822): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (498.05641174316): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (152.8263092041): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 1234.769821167): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (494.95697021484): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (100.13580322266): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (!!!!! 3566.0266876221): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

108 (!!!!! 1389.9803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

109 (104.90417480469): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (921.96464538574): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 10545.015335083): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

112 (794.88754272461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

113 (!!!!! 11852.025985718): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 7906.1985015869): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 2727.0317077637): 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

116 (!!!!! 3281.1164855957): 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 (!!!!! 1607.1796417236): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

118 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

119 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

120 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

121 (855.92269897461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

122 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

123 (554.08477783203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

124 (987.05291748047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

125 (!!!!! 7555.0079345703): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 118014.09721375): 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

127 (!!!!! 1227.855682373): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744917 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744917 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (257.01522827148): ( 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

129 (70.810317993164): ( 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 (720.97778320312): 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

131 (63.180923461914): 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

132 (726.22299194336): 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

133 (41.961669921875): 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

134 (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

135 (339.98489379883): 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

136 (370.97930908203): 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

137 (49.114227294922): 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

138 (!!!!! 1384.0198516846): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (!!!!! 1414.0605926514): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (!!!!! 1489.1624450684): SELECT name FROM jos_deeppockets WHERE id=211

141 (!!!!! 2750.1583099365): SELECT name FROM jos_deeppockets WHERE id=211

142 (699.04327392578): 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

143 (624.17984008789): 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

144 (!!!!! 1775.9799957275): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

145 (!!!!! 1511.0969543457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

146 (!!!!! 17790.079116821): TRUNCATE TABLE jos_trademed_module

147 (!!!!! 8193.9697265625): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (195.02639770508): 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=294744917 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (!!!!! 1063.1084442139): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (339.98489379883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (!!!!! 2990.9610748291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

152 (152.1110534668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

153 (!!!!! 6958.9614868164): 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

154 (!!!!! 1050.9490966797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

155 (359.05838012695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

156 (!!!!! 1287.9371643066): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744917 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744917 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (56.028366088867): 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)

158 (343.08433532715): 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)

159 (!!!!! 1503.9443969727): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (!!!!! 2002.9544830322): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

161 (859.97581481934): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744917 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744917 AND published='1' LIMIT 1

162 (!!!!! 3607.9883575439): select jos_twitters.link from jos_twitters where cat=10

163 (633.95500183105): select jos_facebook.link from jos_facebook where cat=10

164 (51.975250244141): select jos_google_plus.link from jos_google_plus where cat=10

165 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

166 (730.99136352539): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

167 (!!!!! 1405.0006866455): insert into jos_banners_delta values (14615,'2025-08-19 10:43:22','216.73.216.0','view'),(14202,'2025-08-19 10:43:22','216.73.216.0','view'),(14203,'2025-08-19 10:43:22','216.73.216.0','view')

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