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Enfermedad valvular

REC Interv Cardiol. 2021;3:175-181

Tratamiento antiagregante plaquetario único o doble tras implante percutáneo de válvula aórtica. Metanálisis de ensayos clínicos aleatorizados

Single or dual antiplatelet therapy after transcatheter aortic valve implantation. A meta-analysis of randomized controlled trials

Jorge Sanz-Sáncheza,b,c,, Carlo Andrea Pivatoa,b,, Pier Pasquale Leonea,b,, Damiano Regazzolib, Mauro Chiaritoa,b, Gennaro Petriellob, Bernhard Reimersa,b, Gianluigi Condorellia,b y Giulio G. Stefaninia,b,.

aDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milán, Italia

bCardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milán, Italia

cServicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, España

J. Sanz-Sanchez, C. A. Pivato y P. P. Leone han contribuido por igual al articulo.

Contenido relacionado

Corrección en el artículo de Sanz-Sánchez et al., «Tratamiento antiagregante plaquetario único o doble tras implante percutáneo de válvula aórtica. Metanálisis de ensayos clínicos aleatorizados», REC Interv Cardiol. 2021;3:175-181
Jorge Sanz-Sánchez, Carlo Andrea Pivato, Pier Pasquale Leone, Damiano Regazzoli, Mauro Chiarito, Gennaro Petriello, Bernhard Reimers, Gianluigi Condorelli y Giulio G. Stefanini

RESUMEN

Introducción y objetivos: Las guías de práctica clínica actuales recomiendan el tratamiento antiagregante plaquetario doble con ácido acetilsalicílico y clopidogrel como estrategia antitrombótica tras el implante percutáneo de válvula aórtica (TAVI) en pacientes sin indicación de anticoagulación oral a largo plazo. Sin embargo, estas recomendaciones no se han desarrollado de acuerdo con los resultados de grandes ensayos aleatorizados. Por ello, el objetivo de esta investigación es comparar la terapia antiplaquetaria en monoterapia con el tratamiento antiagregante doble en pacientes sin indicación de anticoagulación a largo plazo después de un TAVI.

Métodos: Se realizaron búsquedas en PubMed, Embase y los principales congresos internacionales para encontrar ensayos clínicos aleatorizados que compararan el tratamiento antiagregante único con el tratamiento antiplaquetario doble después de un TAVI. Los datos se agruparon en un metanálisis mediante un modelo de efectos aleatorios. El objetivo principal del estudio fue la hemorragia grave o potencialmente mortal.

Resultados: Se incluyeron cuatro ensayos que en total incluyeron a 1.086 pacientes. Los pacientes bajo tratamiento antiagregante en monoterapia, en comparación con aquellos con tratamiento antiagregante plaquetario doble, tuvieron menor riesgo de hemorragia grave o potencialmente mortal (odds ratio [OR] = 0,44; intervalo de confianza del 95% [IC95%], 0,27-0,70) y de cualquier sangrado (OR = 0,51; IC95%, 0,36-0,71). No se observaron diferencias entre los pacientes tratados con monoterapia y los tratados tratamiento antiagregante plaquetario doble en cuanto a muerte por cualquier causa (OR = 1,01; IC95%, 0,61-1,68), infarto de miocardio (OR = 0,50; IC95%: 0,17-1,41) y accidente cerebrovascular (OR = 0,98; IC95%, 0,54-1,77).

Conclusiones: En los pacientes sin indicación de anticoagulación a largo plazo sometidos a TAVI, la monoterapia con ácido acetilsalicílico en comparación el tratamiento antiagregante doble se asocia con un menor riesgo de hemorragia grave o potencialmente mortal y con un riesgo comparable de muerte por cualquier causa, infarto de miocardio y accidente cerebrovascular.

Palabras clave: Tratamiento antitrombótico. TAVI. Tratamiento antiagregante. Ácido acetilsalicílico. Sangrado.

Abstract

Introduction and objectives: Current expert consensus guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel as antithrombotic strategy after transcatheter aortic valve implantation (TAVI) in patients without an indication for long-term oral anticoagulation. However, these recommendations have not been developed based on the results of large randomized clinical trials. The objective of this study is to compare single antiplatelet therapy (SAPT) to DAPT in patients without an indication for long-term anticoagulation after TAVI.

Methods: The PubMed, Embase, and the main international conference proceedings were reviewed in the search for randomized controlled trials comparing SAPT to DAPT after TAVI. Data were pooled using a meta-analysis and a random effects model. The primary endpoint was life-threatening or major bleeding.

Results: Four trials enrolling 1086 patients were included. Compared to patients treated with DAPT, those treated with SAPT showed a lower risk of life-threatening or major bleeding (OR, 0.44; 95%CI, 0.27-0.70), and any bleeding (OR, 0.51; 95%CI, 0.36-0.71). No differences were observed between patients treated with SAPT compared to those treated with DAPT regarding all-cause mortality (OR, 1.01; 95%CI, 0.61-1.68), myocardial infarction (OR, 0.50; 95%CI 0.17-1.41), and stroke (OR, 0.98; 95%CI, 0.54-1.77).

Conclusions: In patients without an indication for long-term anticoagulation undergoing TAVI, single antiplatelet therapy with aspirin compared to DAPT is associated with a lower risk of life-threatening or major bleeding and a comparable risk of all-cause mortality, myocardial infarction, and stroke.

Keywords: Antithrombotic therapy. TAVI. Antiplatelet therapy. Aspirin. Bleeding.

Abreviaturas: TAPD: tratamiento antiagregante plaquetario doble. ICP: intervención coronaria percutánea. ECA: ensayo clínico aleatorizado. TAP: tratamiento antiagregante plaquetario. TAVI: implante percutáneo de válvula aórtica.

INTRODUCCIÓN

Durante los últimos 20 años, el implante percutáneo de válvula aórtica (TAVI) se ha convertido en una estrategia terapéutica de éxito, alternativa a la cirugía para tratar la estenosis valvular aórtica en pacientes de riesgo quirúrgico alto, intermedio y bajo1,6.

Las complicaciones isquémicas y hemorrágicas no son raras tras un TAVI y pueden ser mortales. Recientemente, los estudios clínicos PARTNER 3 y Evolut Low han mostrado incidencias bajas, aunque nada despreciables, de accidentes cerebrovasculares y hemorragias mayores en los 30 días siguientes a un TAVI5,6.

En la actualidad, el tratamiento antiagregante plaquetario doble (TAPD) con ácido acetilsalicílico y clopidogrel es el régimen antitrombótico más usado tras un TAVI en pacientes sin indicación de anticoagulación oral a largo plazo inscritos en estudios clínicos. Las recomendaciones que dan las guías de diferentes sociedades sugieren cursos de 1 a 3, 3 a 6 o 6 meses de tratamiento con clopidogrel acompañado de dosis bajas de ácido acetilsalicílico. No obstante, estas recomendaciones no se han desarrollado basándose en los resultados de grandes ensayos clínicos aleatorizados7,10. Los datos sobre duraciones del tratamiento realizados en la última década sugieren un efecto neutro o beneficioso del tratamiento antiagregante plaquetario en monoterapia (TAP) frente a un curso inicial de TAPD seguido de TAP en lo que se refiere a las complicaciones vasculares y a las hemorragias mayores o amenazantes para la vida. Estos informes no sugieren mayor riesgo de sufrir infartos de miocardio ni accidentes cerebrovasculares11,13. Recientemente, el ácido acetilsalicílico en monoterapia ha demostrado ser superior a un tratamiento de 3 meses de ácido acetilsalicílico y clopidogrel seguido de ácido acetilsalicílico en lo que se refiere no solo a las hemorragias sino también a las complicaciones tromboembólicas tras 1 año de seguimiento14.

Se realizó un metanálisis de estudios clínicos aleatorizados disponibles para hacer una valoración integral y cuantitativa de la evidencia disponible sobre el perfil de seguridad y eficacia de TAP frente a TAPD tras TAVI en pacientes sin indicación de anticoagulación oral a largo plazo.

MÉTODOS

Estrategia de búsqueda y criterios de selección

Se valoraron ensayos clínicos aleatorizados (ECA) con pacientes tratados de TAVI para incluirlos en este metanálisis. Los estudios elegibles debían cumplir los siguientes criterios de inclusión preespecificados: a) ECA que compararan TAP con TAPD tras un TAVI y b) disponibilidad de datos clínicos. Los criterios de exclusión fueron: a) ECA que incluyeran a pacientes que precisaran anticoagulación oral, b) ausencia de diseño aleatorizado, c) ausencia de datos sobre los resultados clínicos.

Tanto la estrategia de búsqueda, la selección de los estudios, como la extracción y análisis de datos se hicieron siguiendo las directrices de la Colaboración Cochrane y los ítems de referencia para publicar Revisiones Sistemáticas y Metanálisis (PRISMA)15.

El pasado 31 de agosto de 2020, se llevó a cabo una búsqueda en las bases de datos de PubMed y Embase, así como de los resúmenes presentados en importantes congresos científicos (American Heart Association, American College of Cardiology, Sociedad Europea de Cardiología, EuroPCR y Transcatheter Cardiovascular Therapeutics). También se empleó el método backward snowballing (revisión de referencias bibliográficas dentro artículos identificados y revisiones pertinentes). La estrategia de búsqueda está disponible en el material adicional.

Extracción de los datos

Tres investigadores (J. Sanz-Sánchez, C. A. Pivato y P. P. Leone) realizaron una valoración independiente de los estudios con potencial para ser incluidos. El investigador principal (G. G. Stefanini) fue el encargado de resolver cualquier posible discrepancia. Se excluyeron los artículos que no fuesen relevantes en función del título y el resumen. Estos investigadores extrajeron, también de manera independiente, datos sobre el diseño y medidas del estudio, características de los pacientes y resultados con ayuda de un formulario estandarizado para la extracción de datos. Los conflictos sobre a la extracción de datos se debatieron y los resolvió el investigador principal (G. G. Stefanini).

Se recopilaron datos sobre los autores, el año de publicación, los criterios de inclusión y exclusión, el tamaño de la muestra, las características basales de los pacientes, las definiciones de los objetivos, la estimación del efecto conseguido y el tiempo de seguimiento.

Resultados de interés

El objetivo primario preespecificado fue la hemorragia mayor o amenazante para la vida. Los objetivos clínicos secundarios fueron la mortalidad por cualquier causa, el infarto de miocardio, el accidente cerebrovascular y cualquier hemorragia. Cada objetivo se valoró atendiendo a las definiciones descritas en los protocolos originales del estudio que se detallan en la tabla 1 del material adicional.

Tabla 1. Principales características de los estudios

Estudio Año de publicación Diseñodel estudio Número de pacientes Multicéntrico Seguimiento Duración del TAPD
  Global TAPD TAP  
POPular TAVI14 2020 ECA 665 334 331 12 meses 3 meses
ARTE11 2017 ECA 222 111 111 3 meses 3 meses
SAT-TAVI12 2014 ECA 120 60 60 No 6 meses 6 meses
Ussia et al.13 2011 ECA 79 40 39 No 6 meses 3 meses

ECA: ensayo clínico aleatorizado; TAP: tratamiento antiagregante plaquetario; TAPD: tratamiento antiagregante plaquetario doble.

Riesgo de sesgo

El riesgo de sesgo de cada estudio se valoró con la herramienta revisada de evaluación del riesgo de sesgo de la Colaboración Cochrane (RoB 2.0)16. Tres investigadores (J. Sanz-Sánchez, C. A. Pivato y P. P. Leone) realizaron una valoración independiente de 5 dominios de sesgo en cada ECA: 1) proceso de aleatorización, 2) desviaciones de las intervenciones pretendidas, 3) datos de resultados faltantes, 4) medidas de los resultados y 5) selección de los resultados descritos (tabla 2 del material adicional).

Tabla 2. Características clínicas basales de los pacientes incluidos

Estudio Edad (años) Varones Diabetes Hipertensión Fibrilación auricular NYHA ≥ III FEVI Puntuación en la escala STS-PROM Accidente cerebrovascular previo IM previo Abordaje transfemoral Implante valve-in-valve Indicación para TAVI: estenosis aórtica
POPular TAVI14 80 50 24 75 65 2,5 4 9 89 6 98
ARTE11 79 58 35 79 54 6,3 21 69
SAT-TAVI12 81 37 27 95 89 52 10.0 100 100
Ussia et al.13 81 46 27 84 13 62 52 7,3 8 14 ?97 0 100
Global 80 50 27 79 68 53 4,4 12 87 98

FEVI: fracción de eyección del ventrículo izquierdo; IM: infarto de miocardio; NYHA: New York Heart Association; STS-PROM: riesgo de mortalidad predicho por la escala de la Society of Thoracic Surgeons; TAVI: implante percutáneo de válvula aórtica. Los datos expresan porcentajes (%).

Análisis estadístico

Tanto los odds ratios (OR) como los intervalos de confianza (IC) del 95% se calcularon con el modelo de efectos aleatorios de DerSimonian y Laird tomándose el cálculo de la heterogeneidad del método de Mantel-Haenszel. El número de pacientes que es necesario tratar (NNT) para evitar 1 evento se calculó a partir de medidas ponderadas de OR combinados empleando el modelo meta-analítico de efectos aleatorios. La presencia de heterogeneidad entre los diferentes estudios se evaluó con la prueba Q de Cochran según una distribución de X2. Los valores de p ≤ 0,10 se consideraron estadísticamente significativos y la inconsistencia se analizó con la prueba del estadístico I2. Valores del 0% fueron indicativos de ausencia de heterogeneidad observada y valores del ≤ 25%, ≤ 50% y > 50% de la presencia de una heterogeneidad baja, moderada y alta, respectivamente. El sesgo de publicación se valoró por estimación visual a través de gráficos de embudo. Se realizó un análisis de sensibilidad de validación cruzada para el objetivo primario retirando, repetidamente, un estudio cada vez para confirmar que nuestros hallazgos no eran fruto de un único estudio. Los demás análisis de sensibilidad se hicieron calculando los OR con un IC95% a partir de un modelo de efectos fijos con el método de Mantel-Haenszel y los cocientes de tasas de incidencia con un IC95% a partir de modelos de efectos tanto fijos como aleatorios. El nivel de significación estadística se obtuvo a partir de valores de p bilateral < 0,05. Los análisis estadísticos se realizaron empleando el software Stata, versión 13.1 (StataCorp LP, College Station, Estados Unidos).

RESULTADOS

Resultados de la búsqueda

La figura 1 muestra la búsqueda de estudios y el proceso de selección de los mismos según la declaración PRISMA. Se identificó un total de 4 ECA que fueron incluidos en este análisis. Las principales características de los estudios incluidos se muestran en la tabla 1.

Figura 1. Flujograma del proceso de selección de los estudios.

Se incluyó a un total de 541 pacientes en tratamiento con ácido acetilsalicílico y 545 pacientes en tratamiento con TAPD tras TAVI.

Características basales

Las principales características basales de los pacientes incluidos se muestran en la tabla 2. La mayoría de los pacientes recibió un TAVI por presentar estenosis aórtica. El riesgo medio de mortalidad estimada según la Society of Thoracic Surgeons fue del 4,4%, la mayoría de las intervenciones fueron mediante abordaje transfemoral.

Sesgo de publicación y asimetría

Las distribuciones en gráficos de embudo de los resultados preespecificados indican la ausencia de sesgo de publicación para todas las variables clínicas (figuras 1, 5 del material adicional).

Figura 2. Resultados hemorrágicos en pacientes a tratamiento con TAP frente a TAPD tras un TAVI. TAP: tratamiento antiagregante plaquetario; TAPD: tratamiento antiagregante plaquetario doble; TAVI: implante percutáneo de válvula aórtica.

Figura 3. Mortalidad por cualquier causa y resultados de eficacia en pacientes a tratamiento con TAP frente a TAPD tras un TAVI. TAP: tratamiento antiagregante plaquetario; TAPD: tratamiento antiagregante plaquetario doble; TAVI: implante percutáneo de válvula aórtica.

Resultados

Comparados con los tratados con TAPD, los pacientes tratados con TAP tenían menor riesgo de sufrir hemorragias mayores o amenazantes para la vida (OR = 0,44; IC95%, 0,27-0,70; I2 = 0%) y cualquier tipo de hemorragia (OR = 0,51; IC95%, 0,36-0,71; I2 = 0%) (figura 2). No se observaron diferencias entre los pacientes tratados con TAP y los tratados con TAPD en lo que se refiere a la mortalidad por cualquier causa (OR = 1,01; IC95%, 0,61-1,68; I2 = 0%), los infartos de miocardio (OR = 0,50; IC95%, 0,17-1,41; I2 = 0%) y los accidentes cerebrovasculares (OR = 0,98; IC95%, 0,54-1,77; I2 = 0%) (figura 3). El NNT para evitar 1 hemorragia mayor o amenazante para la vida fue de 17 pacientes y el NNT para evitar cualquier tipo de hemorragia fue de 11 pacientes

Evaluación del riesgo de sesgo

La tabla 2 del material adicional muestra los resultados de la evaluación del riesgo de sesgo con la herramienta RoB 2.0. Se consideró que 2 estudios presentaban un riesgo global de sesgo bajo11,14, aunque otros 2 estudios tenían un riesgo algo más alto12,13.

Análisis de sensibilidad

Los hallazgos fueron concordantes con los del análisis principal tras calcular los OR a partir de un modelo de efectos fijos y los cocientes de tasas de incidencias a partir de modelos de efectos tanto fijos como aleatorios (tabla 3 del material adicional).

Los resultados del análisis de sensibilidad de validación cruzada retirando repetidamente un estudio cada vez coincidieron con el análisis primario (tabla 4 del material adicional).

DISCUSIÓN

El presente metanálisis evaluó los ECA disponibles realizando una comparativa entre el TAP con ácido acetilsalicílico y el TAPD en pacientes que recibieron un TAVI sin una indicación para recibir anticoagulación oral a largo plazo. Estos fueron los principales hallazgos:

 

  • 1) El riesgo de sufrir hemorragias mayores o amenazantes para la vida o cualquier otra hemorragia es menor en pacientes tratados con TAP que en aquellos pacientes tratados con TAPD.

  • 2) El riesgo de mortalidad por cualquier causa, infarto de miocardio y accidente cerebrovascular no varió entre las 2 estrategias de tratamiento.

 

En la actualidad, las guías de práctica clínica recomiendan cursos de TAPD de entre 1 y 6 meses de duración tras un TAVI en pacientes sin una indicación para recibir anticoagulación oral a largo plazo7,9. Sin embargo, este régimen no está avalado por las evidencias de que se dispone hoy en día. Esta práctica proviene del campo de las intervenciones coronarias percutáneas en el que la incorporación de un inhibidor del receptor plaquetario P2Y12 al ácido acetilsalicílico, en comparación con una monoterapia con ácido acetilsalicílico, redujo el riesgo de complicaciones isquémicas, sobre todo, la trombosis del stent17. La incorporación de clopidogrel al ácido acetilsalicílico tras un TAVI tiene un potencial teórico de reducir la incidencia de eventos cardiovasculares isquémicos, infartos de miocardio y trombosis valvulares.

El accidente cerebrovascular isquémico es una de las peores complicaciones que se pueden dar tras un TAVI. Su incidencia más alta se da durante las primeras 24 horas después de la intervención. Parece asociarse, principalmente, a la presencia de restos de tejidos embolizados durante el TAVI debido a la dilatación de la válvula calcificada o a la navegación a través del arco aórtico18,20. En cambio, el accidente cerebrovascular subagudo (entre 1 y 30 días después de la intervención), representativo de un cuarto del número total de eventos al cabo de 2 años4,21, con frecuencia se asocia a la fibrilación auricular de nueva aparición22,24, contra la que el TAPD tiene poca efectividad.

Otra motivación teórica para recetar TAPD tras un TAVI es limitar la incidencia de infarto de miocardio. No obstante, la incidencia del infarto de miocardio descrita tras un TAVI es relativamente baja4,21 y la enfermedad coronaria concomitante se suele tratar percutáneamente antes del TAVI. Por lo tanto, la incorporación de un inhibidor del receptor plaquetario P2Y12 al ácido acetilsalicílico tras un TAVI no parece ofrecer ninguna ventaja adicional frente a una monoterapia de ácido acetilsalicílico en lo referente a la reducción del riesgo de infarto de miocardio tal y como confirmaron nuestros resultados.

Por último, aunque la trombosis valvular sintomática es una enfermedad rara (< 1%), la trombosis subclínica tiene una incidencia mucho más alta (entre el 10 y el 40% según diferentes series)25,27. El impacto clínico de este fenómeno todavía se desconoce: podría no solo afectar a la durabilidad de la válvula por la formación de pannus, sino también acarrear una incidencia más alta de accidente isquémico transitorio25,26. En este contexto, la fisiopatología de la formación de trombos tras TAVI sigue siendo objeto de debate ya que todavía hay que establecer el peso relativo que tienen la hemostasia primaria y secundaria. Por otro lado, las lesiones endoteliales y un entorno de alta tensión de cizallamiento alrededor de la estructura endoprotésica de la válvula previo a la re-endotelización podría favorecer la agregación plaquetaria y, por ende, la formación de trombos ricos en plaquetas. Esto es, de algún modo, parecido a lo que sucede durante la trombosis del stent contra la cual el TAPD ha demostrado ser el tratamiento más efectivo17. Por otro lado, el seno bioprotésico de las valvas de la válvula podría favorecer un estado de baja tensión de cizallamiento y turbulencia de flujo y predisponer al desarrollo de trombos ricos en trombina. TAPD parece no ofrecer ningún beneficio sobre TAP en términos de reducir la trombosis de la válvula bioprotésica, pero los anticoagulantes orales sí han demostrado ser capaces de prevenir y resolver esta complicación25,27. No obstante, hasta la fecha, el único estudio que ha entrado a valorar el papel del tratamiento anticoagulante tras un TAVI en pacientes sin una indicación para recibir anticoagulación oral a largo plazo es el GALILEO. El estudio fue interrumpido tras observarse importantes problemas de seguridad en los análisis provisionales que revelaron incidencias más altas de complicaciones con dosis bajas de rivaroxaban/ácido acetilsalicílico frente a TAPD, incluidoseventos clínicos tan importantes como la mortalidad (6,8 frente al 3,3%)28.

En líneas generales, los eventos isquémicos post-TAVI parecen eludir la acción antiagregante plaquetaria de las tienopiridinas y el ácido acetilsalicílico. El presente metanálisis confirma que la incorporación de un inhibidor del receptor plaquetario P2Y12 no reduce el riesgo de sufrir eventos isquémicos (tales como infartos de miocardio y accidentes cerebrovasculares). Más bien predispone a los pacientes a un mayor riesgo de sufrir hemorragias mayores o amenazantes para la vida. El menor riesgo hemorrágico con TAP frente a TAPD descrito en este metanálisis es de una gran importancia clínica con un NNT de tan solo 11 pacientes para evitar cualquier hemorragia y un NNT de 17 pacientes para evitar 1 hemorragia mayor o amenazante para la vida. Además, como la mayoría de los eventos hemorrágicos ocurren dentro de los 30 días siguientes a la intervención, probablemente debido al tratamiento antitrombótico perioperatorio y a las complicaciones hemorrágicas en el sitio de acceso1,4,29, incluso un curso corto de TAPD plantea problemas de seguridad en lo que se refiere a los eventos hemorrágicos.

En base a las evidencias publicadas hasta la fecha y a los resultados de esta investigación, en pacientes sin una indicación para recibir anticoagulación a largo plazo tratados de TAVI, la monoterapia con ácido acetilsalicílico debería preferirse en detrimento del TAPD. No obstante, aún se necesitan estudios extensos que ayuden a determinar si las estrategias antiagregantes plaquetarias deben se individualizadas en función de la válvula implantada (con balón expandible frente a autoexpandible) o en el contexto particular del implante valve-in-valve; así como dilucidar qué papel pueden tener regímenes antiagregantes plaquetarios alternativos (tales como monoterapia con inhibidores del receptor plaquetario P2Y12) y los anticoagulantes orales.

Limitaciones

Los resultados de nuestro estudio se deberían interpretar con cautela teniendo en cuenta ciertas limitaciones. En primer lugar, se trató de un metanálisis a nivel de estudios que ofreció datos sobre los efectos medios del tratamiento. Asimismo, la falta de datos a nivel individual de los pacientes nos impide valorar qué impacto tuvieron las características basales clínicas y la intervención sobre los efectos del tratamiento. En segundo lugar, se observaron pequeñas diferencias en la definición empleada en las variables clínicas isquémicas entre los distintos estudios, lo cual limitó la fiabilidad de las estimaciones del efecto conseguido. No obstante, en lo referente a los eventos hemorrágicos, se usó la definición del VARC en todos los estudios incluidos, lo que aporta solidez a nuestros hallazgos. Por último, el limitado número de estudios y pacientes y el bajo número de eventos para variables como el infarto de miocardio podrían haber atenuado el poder estadístico para detectar cualquier diferencia significativa entre los grupos a estudio.

Se proporcionaran nuevas evidencias por una serie de ECA actualmente en curso: el estudio ATLANTIS (estrategia antitrombótica tras implantación percutánea de válvula aórtica para el tratamiento de la estenosis aórtica; NCT02664649) analizará los beneficios derivados de un tratamiento con una dosis estándar de apixaban frente al tratamiento estándar; el ATAPD-TAVR (anticoagulantes frente a tratamiento antiagregante plaquetario doble para prevenir la trombosis de las valvas y la embolización cerebral tras un implante percutáneo de válvula aórtica; NCT03284827) realizará una comparativa entre un tratamiento con una dosis estándar de edoxaban y el TAPD. Por último, el estudio AUREA (tratamiento antiagregante plaquetario doble frente a un curso corto de anticoagulación para prevenir los embolismos cerebrales tras un TAVI; NCT01642134) valorará una estrategia con antagonistas de la vitamina K frente a un curso de TAPD de 3 meses de duración.

CONCLUSIONES

En pacientes sin una indicación para recibir anticoagulación a largo plazo tratados de TAVI, la monoterapia con ácido acetilsalicílico se asocia a un menor riesgo de sufrir hemorragias mayores o amenazantes para la vida comparado con TAPD y a un riesgo parecido de mortalidad por cualquier causa, infarto de miocardio y accidente cerebrovascular.

FINANCIACIÓN

Ninguna.

CONTRIBUCIÓN DE LOS AUTORES

J. Sanz-Sánchez, C. A. Pivato, P. P. Leone y M. Chiarito contribuyeron al diseño, análisis y redacción de este manuscrito. D. Regazzoli y G. Petriello contribuyeron al diseño y redacción del manuscrito. B. Reimers, G. Condorelli y G. G. Stefanini contribuyeron al diseño, redacción y supervisión de este estudio.

CONFLICTO DE INTERESES

G. G. Stefanini declara haber recibido una beca de investigación de Boston Scientific y honorarios por su labor como conferenciante/consultor para B. Braun, Biosensor y Boston Scientific. D. Regazzoli declara honorarios por su labor como conferenciante para Amgen y Boehringer. Los demás autores no declaran conflicto de intereses.

 

¿QUÉ SE SABE DEL TEMA?

  • Las complicaciones isquémicas y hemorrágicas no son raras tras un TAVI y pueden ser amenazantes para la vida. Con el objetivo de reducir la incidencia de accidentes cerebrovasculares, infartos de miocardio y trombosis valvular, las guías de práctica clínica recomiendan un curso de entre 1 y 6 meses de TAPD tras un TAVI en pacientes sin una indicación para recibir anticoagulación oral a largo plazo. No obstante, este régimen no está avalado por las evidencias disponibles en la actualidad y, en líneas generales, los eventos isquémicos post-TAVI parecen eludir la acción antiagregante plaquetaria de las tienopiridinas y el ácido acetilsalicílico. De hecho, los datos que existen sobre duraciones del tratamiento realizados en la última década sugieren un efecto neutro o beneficioso de la monoterapia con ácido acetilsalicílico frente a un curso inicial de TAPD seguido de ácido acetilsalicílico en monoterapia en lo referente a las complicaciones vasculares y hemorragias mayores o amenazantes para la vida.

¿QUÉ APORTA DE NUEVO?

  • El presente estudio confirma que la incorporación de tienopiridinas al ácido acetilsalicílico no reduce el riesgo de sufrir eventos isquémicos (tales como infartos de miocardio y accidentes cerebrovasculares). Más bien predispone a los pacientes a un mayor riesgo de sufrir hemorragias mayores o amenazantes para la vida. La reducción del riesgo hemorrágico observada con el ácido acetilsalicílico frente al TAPD es de gran importancia clínica con un NNT de solo 11 pacientes para evitar cualquier hemorragia y un NNT de 17 pacientes para evitar 1 hemorragia mayor o amenazante para la vida. En base a las evidencias disponibles publicadas hasta la fecha y a los resultados de este estudio, en pacientes sin una indicación para recibir anticoagulación a largo plazo tratados de TAVI, es preferible una monoterapia con ácido acetilsalicílico en lugar de TAPD.

MATERIAL ADICIONAL


BIBLIOGRAFÍA

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* Autor para correspondencia: Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milán, Italia.

Correo electrónico: giulio.stefanini@gmail.com (G. G. Stefanini).

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  • beforeRenderRawModule mod_menu (Publicaciones Permanyer) (144B) (108μs)
  • afterRenderRawModule mod_menu (Publicaciones Permanyer) (10.24KB) (446μs)
  • beforeRenderModule mod_menu (Publicaciones Permanyer) (720B) (4μs)
  • afterRenderModule mod_menu (Publicaciones Permanyer) (2.89KB) (123μs)
  • beforeRenderRawModule mod_menu (Footer Final ES) (4.92KB) (752μs)
  • afterRenderRawModule mod_menu (Footer Final ES) (28.11KB) (797μs)
  • beforeRenderModule mod_menu (Footer Final ES) (720B) (5μs)
  • afterRenderModule mod_menu (Footer Final ES) (3.33KB) (136μs)
  • afterRender (1.01MB) (82.35ms)
  • 1 x afterRenderModule mod_custom (Lo más compartido) (530.66KB) (35.74%)
    494ms
    1 x afterRenderModule mod_custom (Lo más leído) (1.42MB) (30.87%)
    427ms
    1 x afterRender (1.01MB) (5.96%)
    82.35ms
    1 x afterRenderComponent com_content (283.41KB) (5.15%)
    71.20ms
    1 x Before Access::getAssetRules (id:8 name:com_content) (1.37MB) (2.97%)
    41.08ms
    1 x afterInitialise (3.5MB) (2.39%)
    33.04ms
    1 x afterRenderModule mod_custom (Article Herramientas Estadísticas) (738.55KB) (1.52%)
    21.00ms
    1 x afterRoute (1.02MB) (1.47%)
    20.34ms
    1 x beforeRenderRawModule mod_breadcrumbs (Breadcrumbs ES) (1.1MB) (1.38%)
    19.12ms
    1 x afterRenderModule mod_custom (Debate Title) (660.42KB) (1.05%)
    14.46ms
    1 x afterRenderRawModule mod_dms3_refs (Article Herramientas Exportar) (103.63KB) (0.64%)
    8.79ms
    1 x afterRenderModule mod_custom (Article - Referencia ) (294.66KB) (0.54%)
    7.41ms
    1 x afterRenderModule mod_custom (Article Herramientas Traducción) (276.8KB) (0.54%)
    7.40ms
    1 x afterRenderModule mod_custom (Article DOI activo) (258.95KB) (0.53%)
    7.38ms
    1 x afterRenderModule mod_custom (Article Authors) (1.47MB) (0.53%)
    7.32ms
    1 x afterRenderModule mod_custom (Article Herramientas Compartir) (350.7KB) (0.48%)
    6.65ms
    1 x Before Access::getAssetRules (id:1 name:root.1) (319.39KB) (0.47%)
    6.52ms
    1 x afterRenderModule mod_custom (Article Related contents) (191.7KB) (0.44%)
    6.11ms
    1 x afterDispatch (396.84KB) (0.43%)
    5.92ms
    1 x afterRenderModule mod_custom (Article Category) (231.13KB) (0.4%)
    5.53ms
    1 x afterRenderModule mod_custom (Article Herramientas Material Adicional) (193.26KB) (0.39%)
    5.45ms
    1 x afterRenderModule mod_custom (Innovacion Herramientas Compartir) (218.51KB) (0.37%)
    5.10ms
    1 x afterRenderModule mod_custom (Foto Autor) (167.69KB) (0.36%)
    4.97ms
    1 x afterRenderModule mod_custom (Article Translated Title) (160.8KB) (0.36%)
    4.93ms
    1 x afterRenderModule mod_custom (Article Subtitulo) (161.86KB) (0.34%)
    4.76ms
    1 x afterRenderModule mod_custom (Article Title) (150.27KB) (0.32%)
    4.36ms
    1 x afterRenderModule mod_custom (Innovacion Herramientas Traducción) (151.14KB) (0.3%)
    4.17ms
    1 x afterRenderModule mod_custom (Separador) (128.77KB) (0.3%)
    4.15ms
    1 x afterRenderModule mod_custom (Innovacion Herramientas Estadísticas) (137.62KB) (0.3%)
    4.15ms
    1 x After Access::preloadPermissions (com_content) (988.5KB) (0.29%)
    4.07ms
    1 x afterRenderModule mod_custom (EMAIL Y TWITTER) (129.35KB) (0.29%)
    3.96ms
    1 x afterRenderModule mod_custom (Article Herramientas Imprimir) (128.43KB) (0.29%)
    3.95ms
    1 x afterRenderModule mod_custom (Article Herramientas Descargar) (127.94KB) (0.28%)
    3.93ms
    1 x afterRenderModule mod_custom (Innovacion Herramientas Imprimir) (128.27KB) (0.28%)
    3.91ms
    1 x afterLoad (74.89KB) (0.21%)
    2.95ms
    1 x beforeRenderRawModule mod_custom (Publicación de la Sociedad Española de Cardiología) (13.2KB) (0.17%)
    2.39ms
    1 x afterRenderRawModule mod_languages (Cambiar Idioma) (36.36KB) (0.13%)
    1.78ms
    1 x afterRenderRawModule mod_articles_good_search (Articles Good Search Total (Lateral)) (34.63KB) (0.1%)
    1.44ms
    1 x afterRenderRawModule mod_breadcrumbs (Breadcrumbs ES) (13.98KB) (0.08%)
    1.10ms
    1 x afterRenderModule mod_custom (Home Concurso Hemodinamica) (6.23KB) (0.07%)
    936μs
    1 x beforeRenderRawModule mod_custom (Separador) (2.04KB) (0.07%)
    912μs
    1 x After Access::preloadComponents (all components) (125.96KB) (0.06%)
    858μs
    1 x afterRenderRawModule mod_menu (Publicar) (29.84KB) (0.06%)
    828μs
    1 x afterRenderRawModule mod_menu (Footer Final ES) (28.11KB) (0.06%)
    797μs
    1 x Before Access::preloadComponents (all components) (196.7KB) (0.06%)
    791μs
    1 x afterRenderRawModule mod_menu (Sidebar Menú ES) (9.75KB) (0.06%)
    770μs
    1 x beforeRenderRawModule mod_menu (Footer Final ES) (4.92KB) (0.05%)
    752μs
    1 x afterRenderRawModule mod_menu (Sobre nosotros) (22.34KB) (0.05%)
    736μs
    1 x afterRenderRawModule mod_menu (Contenido) (18.63KB) (0.05%)
    690μs
    1 x beforeRenderRawModule mod_menu (Contenido) (4.84KB) (0.05%)
    652μs
    1 x afterRenderRawModule mod_menu (Sidebar - REC: Publications) (16.07KB) (0.04%)
    542μs
    1 x afterRenderRawModule mod_menu (Publicaciones Permanyer) (10.24KB) (0.03%)
    446μs
    1 x afterRenderRawModule mod_custom (Debate Title) (4.13KB) (0.03%)
    440μs
    1 x beforeRenderRawModule mod_custom (Debate Title) (4.12KB) (0.03%)
    382μs
    1 x afterRenderModule mod_breadcrumbs (Breadcrumbs ES) (3.88KB) (0.03%)
    367μs
    1 x beforeRenderComponent com_content (12.8KB) (0.02%)
    340μs
    1 x afterRenderRawModule mod_lightbox (Lightbox) (83.07KB) (0.02%)
    332μs
    1 x afterRenderModule mod_articles_good_search (Articles Good Search Total (Lateral)) (10.48KB) (0.02%)
    285μs
    1 x afterRenderRawModule mod_esmedicodisclaimer (esmedicodisclaimer esmedicodisclaimer) (7.09KB) (0.02%)
    278μs
    1 x beforeRenderRawModule mod_custom (Home Concurso Hemodinamica) (80B) (0.02%)
    255μs
    1 x afterRenderModule mod_custom (Publicación de la Sociedad Española de Cardiología) (2.81KB) (0.01%)
    201μs
    1 x afterRenderModule mod_languages (Cambiar Idioma) (4.22KB) (0.01%)
    164μs
    1 x afterRenderModule mod_lightbox (Lightbox) (4.45KB) (0.01%)
    151μs
    1 x afterRenderRawModule mod_custom (Lo más compartido) (912B) (0.01%)
    149μs
    1 x afterRenderModule mod_esmedicodisclaimer (esmedicodisclaimer esmedicodisclaimer) (5.48KB) (0.01%)
    141μs
    1 x afterRenderModule mod_menu (Sidebar Menú ES) (2.7KB) (0.01%)
    140μs
    1 x afterRenderModule mod_menu (Footer Final ES) (3.33KB) (0.01%)
    136μs
    1 x beforeRenderRawModule mod_lightbox (Lightbox) (7.17KB) (0.01%)
    132μs
    1 x afterRenderModule mod_menu (Contenido) (3.08KB) (0.01%)
    131μs
    1 x afterRenderModule mod_custom (Factor de Impacto) (2.84KB) (0.01%)
    129μs
    1 x afterRenderModule mod_menu (Sidebar - REC: Publications) (3.23KB) (0.01%)
    128μs
    1 x afterRenderModule mod_menu (Sobre nosotros) (3.2KB) (0.01%)
    128μs
    1 x afterRenderModule mod_menu (Publicar) (3.33KB) (0.01%)
    125μs
    1 x beforeRenderRawModule mod_menu (Publicar) (1.61KB) (0.01%)
    124μs
    1 x afterRenderModule mod_menu (Publicaciones Permanyer) (2.89KB) (0.01%)
    123μs
    1 x afterRenderModule mod_dms3_refs (Article Herramientas Exportar) (3.36KB) (0.01%)
    122μs
    1 x beforeRenderRawModule mod_menu (Sobre nosotros) (160B) (0.01%)
    116μs
    1 x afterRenderRawModule mod_custom (Publicación de la Sociedad Española de Cardiología) (1.09KB) (0.01%)
    115μs
    1 x beforeRenderRawModule mod_languages (Cambiar Idioma) (5.38KB) (0.01%)
    111μs
    1 x beforeRenderRawModule mod_menu (Publicaciones Permanyer) (144B) (0.01%)
    108μs
    1 x afterRenderRawModule mod_custom (Separador) (1.13KB) (0.01%)
    107μs
    1 x After Access::getAssetRules (id:1150 name:com_content.article.643) (9.4KB) (0.01%)
    100μs
    1 x afterRenderRawModule mod_custom (Foto Autor) (1.02KB) (0.01%)
    88μs
    1 x afterRenderRawModule mod_custom (Article DOI activo) (1.02KB) (0.01%)
    87μs
    1 x afterRenderRawModule mod_custom (Article Authors) (976B) (0.01%)
    87μs
    1 x afterRenderRawModule mod_custom (Article Related contents) (928B) (0.01%)
    87μs
    1 x afterRenderRawModule mod_custom (Factor de Impacto) (976B) (0.01%)
    86μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Descargar) (992B) (0.01%)
    86μs
    1 x afterRenderRawModule mod_custom (Article Category) (1.02KB) (0.01%)
    85μs
    1 x afterRenderRawModule mod_custom (Article Title) (976B) (0.01%)
    85μs
    1 x afterRenderRawModule mod_custom (Article - Referencia ) (3.52KB) (0.01%)
    85μs
    1 x afterRenderRawModule mod_custom (Article Translated Title) (992B) (0.01%)
    84μs
    1 x afterRenderRawModule mod_custom (Innovacion Herramientas Estadísticas) (928B) (0.01%)
    84μs
    1 x afterRenderRawModule mod_custom (Home Concurso Hemodinamica) (928B) (0.01%)
    83μs
    1 x afterRenderRawModule mod_custom (Article Subtitulo) (976B) (0.01%)
    82μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Estadísticas) (928B) (0.01%)
    79μs
    1 x afterRenderRawModule mod_custom (Lo más leído) (912B) (0.01%)
    78μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Compartir) (928B) (0.01%)
    78μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Imprimir) (928B) (0.01%)
    77μs
    1 x afterRenderRawModule mod_custom (Innovacion Herramientas Compartir) (928B) (0.01%)
    77μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Material Adicional) (944B) (0.01%)
    77μs
    1 x afterRenderRawModule mod_custom (Article Herramientas Traducción) (1.16KB) (0.01%)
    76μs
    1 x afterRenderRawModule mod_custom (Innovacion Herramientas Traducción) (1.03KB) (0.01%)
    76μs
    1 x afterRenderRawModule mod_custom (Innovacion Herramientas Imprimir) (928B) (0.01%)
    76μs
    1 x afterRenderRawModule mod_custom (EMAIL Y TWITTER) (1.02KB) (0.01%)
    76μs
    1 x beforeRenderRawModule mod_custom (Lo más compartido) (1.13KB) (0%)
    54μs
    1 x Before Access::getAssetRules (id:1150 name:com_content.article.643) (66.8KB) (0%)
    46μs
    1 x beforeRenderRawModule mod_articles_good_search (Articles Good Search Total (Lateral)) (9.48KB) (0%)
    41μs
    1 x beforeRenderRawModule mod_custom (Factor de Impacto) (13.19KB) (0%)
    37μs
    1 x beforeRenderRawModule mod_custom (Article Authors) (1.5KB) (0%)
    35μs
    1 x beforeRenderRawModule mod_custom (Innovacion Herramientas Estadísticas) (5.47KB) (0%)
    33μs
    1 x beforeRenderRawModule mod_custom (Article Related contents) (1.64KB) (0%)
    31μs
    1 x beforeRenderRawModule mod_custom (Article Category) (2KB) (0%)
    30μs
    1 x beforeRenderRawModule mod_custom (Article DOI activo) (1.22KB) (0%)
    29μs
    1 x beforeRenderRawModule mod_custom (Foto Autor) (1.44KB) (0%)
    29μs
    1 x beforeRenderRawModule mod_custom (Article - Referencia ) (1.61KB) (0%)
    28μs
    1 x beforeRenderRawModule mod_custom (Article Title) (1.69KB) (0%)
    28μs
    1 x beforeRenderRawModule mod_custom (Article Translated Title) (1.61KB) (0%)
    28μs
    1 x beforeRenderRawModule mod_custom (Article Subtitulo) (1.19KB) (0%)
    27μs
    1 x beforeRenderRawModule mod_menu (Sidebar Menú ES) (768B) (0%)
    25μs
    1 x beforeRenderRawModule mod_menu (Sidebar - REC: Publications) (1.61KB) (0%)
    23μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Descargar) (1.45KB) (0%)
    23μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Material Adicional) (3.53KB) (0%)
    22μs
    1 x beforeRenderRawModule mod_custom (Innovacion Herramientas Traducción) (2.11KB) (0%)
    22μs
    1 x beforeRenderRawModule mod_custom (EMAIL Y TWITTER) (1.66KB) (0%)
    22μs
    1 x beforeRenderRawModule mod_custom (Innovacion Herramientas Compartir) (6.36KB) (0%)
    22μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Estadísticas) (3.52KB) (0%)
    22μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Traducción) (1.48KB) (0%)
    21μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Imprimir) (1.39KB) (0%)
    21μs
    1 x beforeRenderRawModule mod_custom (Innovacion Herramientas Imprimir) (1.48KB) (0%)
    21μs
    1 x beforeRenderRawModule mod_dms3_refs (Article Herramientas Exportar) (2.83KB) (0%)
    20μs
    1 x beforeRenderRawModule mod_custom (Article Herramientas Compartir) (432B) (0%)
    20μs
    1 x beforeRenderRawModule mod_esmedicodisclaimer (esmedicodisclaimer esmedicodisclaimer) (2.36KB) (0%)
    20μs
    1 x beforeRenderRawModule mod_custom (Lo más leído) (2.39KB) (0%)
    19μs
    1 x After Access::getAssetRules (id:1 name:root.1) (7.41KB) (0%)
    18μs
    1 x After Access::getAssetRules (id:8 name:com_content) (1.59KB) (0%)
    12μs
    1 x Before Access::preloadPermissions (com_content) (4.16KB) (0%)
    10μs
    1 x beforeRenderModule mod_breadcrumbs (Breadcrumbs ES) (704B) (0%)
    5μs
    1 x beforeRenderModule mod_languages (Cambiar Idioma) (704B) (0%)
    5μs
    1 x beforeRenderModule mod_menu (Sidebar Menú ES) (720B) (0%)
    5μs
    1 x beforeRenderModule mod_custom (Lo más compartido) (720B) (0%)
    5μs
    1 x beforeRenderModule mod_menu (Footer Final ES) (720B) (0%)
    5μs
    1 x beforeRenderModule mod_custom (Publicación de la Sociedad Española de Cardiología) (752B) (0%)
    4μs
    1 x beforeRenderModule mod_lightbox (Lightbox) (720B) (0%)
    4μs
    1 x beforeRenderModule mod_articles_good_search (Articles Good Search Total (Lateral)) (752B) (0%)
    4μs
    1 x beforeRenderModule mod_menu (Sidebar - REC: Publications) (736B) (0%)
    4μs
    1 x beforeRenderModule mod_menu (Contenido) (704B) (0%)
    4μs
    1 x beforeRenderModule mod_menu (Publicaciones Permanyer) (720B) (0%)
    4μs
    1 x beforeRenderModule mod_dms3_refs (Article Herramientas Exportar) (736B) (0%)
    4μs
    1 x beforeRenderModule mod_menu (Sobre nosotros) (720B) (0%)
    4μs
    1 x beforeRenderModule mod_custom (Article Subtitulo) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Home Concurso Hemodinamica) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Lo más leído) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Innovacion Herramientas Traducción) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Imprimir) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Innovacion Herramientas Imprimir) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Compartir) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_esmedicodisclaimer (esmedicodisclaimer esmedicodisclaimer) (752B) (0%)
    3μs
    1 x beforeRenderModule mod_menu (Publicar) (704B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Debate Title) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article DOI activo) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Category) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Foto Autor) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Title) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Translated Title) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Authors) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Related contents) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Factor de Impacto) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Separador) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Descargar) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Traducción) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (EMAIL Y TWITTER) (720B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Estadísticas) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article Herramientas Material Adicional) (736B) (0%)
    3μs
    1 x beforeRenderModule mod_custom (Article - Referencia ) (720B) (0%)
    2μs
    1 x beforeRenderModule mod_custom (Innovacion Herramientas Compartir) (736B) (0%)
    2μs
    1 x beforeRenderModule mod_custom (Innovacion Herramientas Estadísticas) (736B) (0%)
    2μs
95 statements were executed, 23 of which were duplicates, 72 unique924ms2.13MB
  • SELECT @@SESSION.sql_mode;220μs1.57KB/libraries/vendor/joomla/database/src/Mysqli/MysqliDriver.php:308Copy
  • SELECT `data` FROM `yzfp0_session` WHERE `session_id` = ?189μs1.63KBParams/libraries/vendor/joomla/session/src/Handler/DatabaseHandler.php:250Copy
  • SELECT `session_id` FROM `yzfp0_session` WHERE `session_id` = :session_id LIMIT 1146μs1.63KBParams/libraries/src/Session/MetadataManager.php:187Copy
  • UPDATE `yzfp0_session` SET `guest` = :guest , `time` = :time , `userid` = :user_id , `username` = :username , `client_id` = :client_id WHERE `session_id` = :session_id144μs992BParams/libraries/src/Session/MetadataManager.php:316Copy
  • SELECT `extension_id` AS `id`,`element` AS `option`,`params`,`enabled` FROM `yzfp0_extensions` WHERE `type` = 'component' AND `state` = 0 AND `enabled` = 1267μs2.31KB/libraries/src/Component/ComponentHelper.php:399Copy
  • SELECT `id`,`rules` FROM `yzfp0_viewlevels`117μs976B/libraries/src/Access/Access.php:955Copy
  • SELECT `b`.`id` FROM `yzfp0_usergroups` AS `a` LEFT JOIN `yzfp0_usergroups` AS `b` ON `b`.`lft` <= `a`.`lft` AND `b`.`rgt` >= `a`.`rgt` WHERE `a`.`id` = :guest214μs1.64KBParams/libraries/src/Access/Access.php:868Copy
  • SELECT `folder` AS `type`,`element` AS `name`,`params` AS `params`,`extension_id` AS `id` FROM `yzfp0_extensions` WHERE `enabled` = 1 AND `type` = 'plugin' AND `state` IN (0,1) AND `access` IN (:preparedArray1,:preparedArray2) ORDER BY `ordering`615μs21.8KBParams/libraries/src/Plugin/PluginHelper.php:294Copy
  • SELECT * FROM `yzfp0_languages` WHERE `published` = 1 ORDER BY `ordering` ASC148μs3.48KB/libraries/src/Language/LanguageHelper.php:177Copy
  • SELECT `element`,`name`,`client_id`,`extension_id` FROM `yzfp0_extensions` WHERE `type` = 'language' AND `state` = 0 AND `enabled` = 1160μs1.08KB/libraries/src/Language/LanguageHelper.php:250Copy
  • SELECT `m`.`id`,`m`.`menutype`,`m`.`title`,`m`.`alias`,`m`.`note`,`m`.`link`,`m`.`type`,`m`.`level`,`m`.`language`,`m`.`browserNav`,`m`.`access`,`m`.`params`,`m`.`home`,`m`.`img`,`m`.`template_style_id`,`m`.`component_id`,`m`.`parent_id`,`m`.`path` AS `route`,`e`.`element` AS `component` FROM `yzfp0_menu` AS `m` LEFT JOIN `yzfp0_extensions` AS `e` ON `m`.`component_id` = `e`.`extension_id` WHERE ( (`m`.`published` = 1 AND `m`.`parent_id` > 0 AND `m`.`client_id` = 0) AND (`m`.`publish_up` IS NULL OR `m`.`publish_up` <= :currentDate1)) AND (`m`.`publish_down` IS NULL OR `m`.`publish_down` >= :currentDate2) ORDER BY `m`.`lft`1.31ms200.55KBParams/libraries/src/Menu/SiteMenu.php:166Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray1,:preparedArray2)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`323μs5.17KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `id` FROM `yzfp0_content` WHERE `alias` = :alias AND `catid` = :catid196μs1.65KBParams/components/com_content/src/Service/Router.php:263Copy
  • SELECT `id`,`home`,`template`,`s`.`params`,`inheritable`,`parent` FROM `yzfp0_template_styles` AS `s` LEFT JOIN `yzfp0_extensions` AS `e` ON `e`.`element` = `s`.`template` AND `e`.`type` = 'template' AND `e`.`client_id` = `s`.`client_id` WHERE `s`.`client_id` = 0 AND `e`.`enabled` = 1267μs1.55KB/administrator/components/com_templates/src/Model/StyleModel.php:775Copy
  • SELECT s.id, s.template, s.home, s.title AS long_title, s.params FROM yzfp0_template_styles AS s WHERE s.client_id = 0 AND s.template = 'g5_helium' ORDER BY s.id198μs1.48KB/libraries/gantry5/src/classes/Gantry/Joomla/StyleHelper.php:69Copy
  • SELECT `id`,`name`,`rules`,`parent_id` FROM `yzfp0_assets` WHERE `name` IN (:preparedArray1,:preparedArray2,:preparedArray3,:preparedArray4,:preparedArray5,:preparedArray6,:preparedArray7,:preparedArray8,:preparedArray9,:preparedArray10,:preparedArray11,:preparedArray12,:preparedArray13,:preparedArray14,:preparedArray15,:preparedArray16,:preparedArray17,:preparedArray18,:preparedArray19,:preparedArray20,:preparedArray21,:preparedArray22,:preparedArray23,:preparedArray24,:preparedArray25,:preparedArray26,:preparedArray27,:preparedArray28,:preparedArray29,:preparedArray30,:preparedArray31,:preparedArray32,:preparedArray33,:preparedArray34,:preparedArray35,:preparedArray36,:preparedArray37,:preparedArray38,:preparedArray39,:preparedArray40,:preparedArray41,:preparedArray42,:preparedArray43,:preparedArray44,:preparedArray45,:preparedArray46)513μs8.12KBParams/libraries/src/Access/Access.php:357Copy
  • SELECT `id`,`name`,`rules`,`parent_id` FROM `yzfp0_assets` WHERE `name` LIKE :asset OR `name` = :extension OR `parent_id` = 02.82ms96.3KBParams/libraries/src/Access/Access.php:301Copy
  • SHOW FULL COLUMNS FROM `yzfp0_content`359μs2.39KB/libraries/vendor/joomla/database/src/Mysqli/MysqliDriver.php:587Copy
  • UPDATE `yzfp0_content` SET `hits` = (`hits` + 1) WHERE `id` = '643'449μs48B/libraries/src/Table/Table.php:1348Copy
  • SELECT `a`.`id`,`a`.`asset_id`,`a`.`title`,`a`.`alias`,`a`.`introtext`,`a`.`fulltext`,`a`.`state`,`a`.`catid`,`a`.`created`,`a`.`created_by`,`a`.`created_by_alias`,`a`.`modified`,`a`.`modified_by`,`a`.`checked_out`,`a`.`checked_out_time`,`a`.`publish_up`,`a`.`publish_down`,`a`.`images`,`a`.`urls`,`a`.`attribs`,`a`.`version`,`a`.`ordering`,`a`.`metakey`,`a`.`metadesc`,`a`.`access`,`a`.`hits`,`a`.`metadata`,`a`.`featured`,`a`.`language`,`fp`.`featured_up`,`fp`.`featured_down`,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`language` AS `category_language`,`fp`.`ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,`parent`.`language` AS `parent_language`,ROUND(`v`.`rating_sum` / `v`.`rating_count`, 1) AS `rating`,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_content_frontpage` AS `fp` ON `fp`.`content_id` = `a`.`id` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `a`.`id` = `v`.`content_id` WHERE ( (`a`.`id` = :pk AND `c`.`published` > 0 AND `a`.`language` IN (:preparedArray1,:preparedArray2)) AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= :publishUp)) AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` >= :publishDown) AND `a`.`state` IN (:preparedArray3,:preparedArray4)360μs104.69KBParams/components/com_content/src/Model/ArticleModel.php:215Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`337μs5.23KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `m`.`tag_id`,`t`.* FROM `yzfp0_contentitem_tag_map` AS `m` INNER JOIN `yzfp0_tags` AS `t` ON `m`.`tag_id` = `t`.`id` WHERE `m`.`type_alias` = :contentType AND `m`.`content_item_id` = :id AND `t`.`published` = 1 AND `t`.`access` IN (:preparedArray1,:preparedArray2)411μs5.23KBParams/libraries/src/Helper/TagsHelper.php:388Copy
  • SHOW FULL COLUMNS FROM `yzfp0_users`306μs2.2KB/libraries/vendor/joomla/database/src/Mysqli/MysqliDriver.php:587Copy
  • SELECT * FROM `yzfp0_users` WHERE `id` = :userid159μs4.41KBParams/libraries/src/Table/User.php:106Copy
  • SELECT `g`.`id`,`g`.`title` FROM `yzfp0_usergroups` AS `g` INNER JOIN `yzfp0_user_usergroup_map` AS `m` ON `m`.`group_id` = `g`.`id` WHERE `m`.`user_id` = :muserid160μs1.68KBParams/libraries/src/Table/User.php:134Copy
  • SELECT * FROM `yzfp0_users` WHERE `id` = :userid151μs4.41KBParams/libraries/src/Table/User.php:106Copy
  • SELECT `g`.`id`,`g`.`title` FROM `yzfp0_usergroups` AS `g` INNER JOIN `yzfp0_user_usergroup_map` AS `m` ON `m`.`group_id` = `g`.`id` WHERE `m`.`user_id` = :muserid146μs1.68KBParams/libraries/src/Table/User.php:134Copy
  • SELECT `b`.`id` FROM `yzfp0_user_usergroup_map` AS `map` LEFT JOIN `yzfp0_usergroups` AS `a` ON `a`.`id` = `map`.`group_id` LEFT JOIN `yzfp0_usergroups` AS `b` ON `b`.`lft` <= `a`.`lft` AND `b`.`rgt` >= `a`.`rgt` WHERE `map`.`user_id` = :userId156μs1.64KBParams/libraries/src/Access/Access.php:868Copy
  • SELECT r.* FROM yzfp0_rereplacer AS r WHERE r.published = 1 AND (r.area = 'articles' OR r.params LIKE '%\"use_xml\":\"1\"%') ORDER BY r.ordering, r.id303μs2.11KB/plugins/system/rereplacer/src/Items.php:97Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`311μs5.23KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT DISTINCT a.id, a.title, a.name, a.checked_out, a.checked_out_time, a.note, a.state, a.access, a.created_time, a.created_user_id, a.ordering, a.language, a.fieldparams, a.params, a.type, a.default_value, a.context, a.group_id, a.label, a.description, a.required, a.only_use_in_subform,l.title AS language_title, l.image AS language_image,uc.name AS editor,ag.title AS access_level,ua.name AS author_name,g.title AS group_title, g.access as group_access, g.state AS group_state, g.note as group_note FROM yzfp0_fields AS a LEFT JOIN `yzfp0_languages` AS l ON l.lang_code = a.language LEFT JOIN yzfp0_users AS uc ON uc.id=a.checked_out LEFT JOIN yzfp0_viewlevels AS ag ON ag.id = a.access LEFT JOIN yzfp0_users AS ua ON ua.id = a.created_user_id LEFT JOIN yzfp0_fields_groups AS g ON g.id = a.group_id LEFT JOIN `yzfp0_fields_categories` AS fc ON fc.field_id = a.id WHERE ( (`a`.`context` = :context AND (`fc`.`category_id` IS NULL OR `fc`.`category_id` IN (:preparedArray1,:preparedArray2,:preparedArray3)) AND `a`.`access` IN (:preparedArray4,:preparedArray5)) AND (`a`.`group_id` = 0 OR `g`.`access` IN (:preparedArray6,:preparedArray7)) AND `a`.`state` = :state) AND (`a`.`group_id` = 0 OR `g`.`state` = :gstate) AND `a`.`only_use_in_subform` = :only_use_in_subform AND `a`.`language` IN (:preparedArray8,:preparedArray9) ORDER BY a.ordering ASC1.22ms54.94KBParams/libraries/src/MVC/Model/BaseDatabaseModel.php:164Copy
  • SELECT `field_id`,`value` FROM `yzfp0_fields_values` WHERE `field_id` IN (:preparedArray1,:preparedArray2,:preparedArray3,:preparedArray4,:preparedArray5,:preparedArray6,:preparedArray7,:preparedArray8,:preparedArray9,:preparedArray10,:preparedArray11,:preparedArray12,:preparedArray13,:preparedArray14,:preparedArray15,:preparedArray16,:preparedArray17,:preparedArray18,:preparedArray19,:preparedArray20,:preparedArray21,:preparedArray22,:preparedArray23,:preparedArray24,:preparedArray25,:preparedArray26,:preparedArray27,:preparedArray28,:preparedArray29,:preparedArray30,:preparedArray31,:preparedArray32,:preparedArray33,:preparedArray34,:preparedArray35,:preparedArray36,:preparedArray37,:preparedArray38,:preparedArray39,:preparedArray40,:preparedArray41,:preparedArray42,:preparedArray43,:preparedArray44,:preparedArray45,:preparedArray46,:preparedArray47,:preparedArray48,:preparedArray49) AND `item_id` = :itemid808μs7.77KBParams/administrator/components/com_fields/src/Model/FieldModel.php:747Copy
  • SELECT a.id,a.asset_id,a.title,a.alias,a.introtext,a.fulltext,a.state,a.catid,a.created,a.created_by,a.created_by_alias,CASE WHEN a.modified = '0000-00-00 00:00:00' THEN a.created ELSE a.modified END as modified,a.modified_by,a.checked_out,a.checked_out_time,a.publish_up,a.publish_down,a.images,a.urls,a.attribs,a.version,a.ordering,a.metakey,a.metadesc,a.access,a.hits,a.metadata,a.featured,a.language,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`lft` AS `category_lft`,`c`.`lft` AS `category_ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,ROUND(v.rating_sum / v.rating_count, 0) AS rating,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `v`.`content_id` = `a`.`id` WHERE `a`.`id` = 631 AND `c`.`published` > 0 AND (`a`.`state` = 1 AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= '2024-12-03 01:09:58') AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` = '0000-00-00 00:00:00' OR `a`.`publish_down` > '2024-12-03 01:09:58'))414μs106.44KB/libraries/regularlabs/src/Article.php:94Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`352μs5.22KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `a`.`id`,`a`.`asset_id`,`a`.`title`,`a`.`alias`,`a`.`introtext`,`a`.`fulltext`,`a`.`state`,`a`.`catid`,`a`.`created`,`a`.`created_by`,`a`.`created_by_alias`,`a`.`modified`,`a`.`modified_by`,`a`.`checked_out`,`a`.`checked_out_time`,`a`.`publish_up`,`a`.`publish_down`,`a`.`images`,`a`.`urls`,`a`.`attribs`,`a`.`version`,`a`.`ordering`,`a`.`metakey`,`a`.`metadesc`,`a`.`access`,`a`.`hits`,`a`.`metadata`,`a`.`featured`,`a`.`language`,`fp`.`featured_up`,`fp`.`featured_down`,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`language` AS `category_language`,`fp`.`ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,`parent`.`language` AS `parent_language`,ROUND(`v`.`rating_sum` / `v`.`rating_count`, 1) AS `rating`,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_content_frontpage` AS `fp` ON `fp`.`content_id` = `a`.`id` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `a`.`id` = `v`.`content_id` WHERE ( (`a`.`id` = :pk AND `c`.`published` > 0 AND `a`.`language` IN (:preparedArray1,:preparedArray2)) AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= :publishUp)) AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` >= :publishDown) AND `a`.`state` IN (:preparedArray3,:preparedArray4)331μs104.73KBParams/components/com_content/src/Model/ArticleModel.php:215Copy
  • SELECT `m`.`tag_id`,`t`.* FROM `yzfp0_contentitem_tag_map` AS `m` INNER JOIN `yzfp0_tags` AS `t` ON `m`.`tag_id` = `t`.`id` WHERE `m`.`type_alias` = :contentType AND `m`.`content_item_id` = :id AND `t`.`published` = 1 AND `t`.`access` IN (:preparedArray1,:preparedArray2)308μs5.23KBParams/libraries/src/Helper/TagsHelper.php:388Copy
  • SELECT c.id FROM yzfp0_content AS c LEFT JOIN yzfp0_fields_values AS f1 ON c.id = f1.item_id AND f1.field_id = (SELECT id FROM yzfp0_fields WHERE name = "orden-nuevo") LEFT JOIN yzfp0_fields_values AS f2 ON c.id = f2.item_id AND f2.field_id = (SELECT id FROM yzfp0_fields WHERE name = "dms3-volumen") LEFT JOIN yzfp0_fields_values AS f3 ON c.id = f3.item_id AND f3.field_id = (SELECT id FROM yzfp0_fields WHERE name = "dms3-numero") WHERE c.language = 'es-ES' AND f1.value = '6' AND f2.value = '3' AND f3.value = '3' LIMIT 119.39ms856B/plugins/content/dms3articlenavigation/dms3articlenavigation.php:168Copy
  • SELECT c.id FROM yzfp0_content AS c LEFT JOIN yzfp0_fields_values AS f1 ON c.id = f1.item_id AND f1.field_id = (SELECT id FROM yzfp0_fields WHERE name = "orden-nuevo") LEFT JOIN yzfp0_fields_values AS f2 ON c.id = f2.item_id AND f2.field_id = (SELECT id FROM yzfp0_fields WHERE name = "dms3-volumen") LEFT JOIN yzfp0_fields_values AS f3 ON c.id = f3.item_id AND f3.field_id = (SELECT id FROM yzfp0_fields WHERE name = "dms3-numero") WHERE c.language = 'es-ES' AND f1.value = '4' AND f2.value = '3' AND f3.value = '3' LIMIT 110.63ms856B/plugins/content/dms3articlenavigation/dms3articlenavigation.php:168Copy
  • SELECT `catid`,`alias`,`language` FROM `yzfp0_content` WHERE `id` = '628'229μs976B/plugins/content/dms3articlenavigation/dms3articlenavigation.php:227Copy
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  • SELECT `language`,`id` FROM `yzfp0_menu` WHERE `home` = '1' AND `published` = 1 AND `client_id` = 0238μs944B/libraries/src/Language/Multilanguage.php:123Copy
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  • SELECT `alias` FROM `yzfp0_content` WHERE `id` = :id108μs1.63KBParams/components/com_content/src/Service/Router.php:168Copy
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  • SELECT `m`.`id`,`m`.`title`,`m`.`module`,`m`.`position`,`m`.`content`,`m`.`showtitle`,`m`.`params`,`mm`.`menuid` FROM `yzfp0_modules` AS `m` LEFT JOIN `yzfp0_modules_menu` AS `mm` ON `mm`.`moduleid` = `m`.`id` LEFT JOIN `yzfp0_extensions` AS `e` ON `e`.`element` = `m`.`module` AND `e`.`client_id` = `m`.`client_id` WHERE ( ( (`m`.`published` = 1 AND `e`.`enabled` = 1 AND `m`.`client_id` = :clientId AND `m`.`access` IN (:preparedArray1,:preparedArray2)) AND (`m`.`publish_up` IS NULL OR `m`.`publish_up` <= :publishUp)) AND (`m`.`publish_down` IS NULL OR `m`.`publish_down` >= :publishDown)) AND (`mm`.`menuid` = :itemId OR `mm`.`menuid` <= 0) AND `m`.`language` IN (:preparedArray3,:preparedArray4) ORDER BY `m`.`position`,`m`.`ordering`1.57ms163.91KBParams/libraries/src/Cache/Controller/CallbackController.php:51Copy
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  • SHOW FULL COLUMNS FROM `yzfp0_content`365μs2.39KB/libraries/vendor/joomla/database/src/Mysqli/MysqliDriver.php:587Copy
  • SELECT field.name,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[804] RegularLabs.Plugin.System.ArticlesAnywhere.DataGroups.Field.getFieldNames\n[799] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_fields` AS `field` WHERE field.context = 'com_content.article'283μs34.13KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[779] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 LIMIT 1148μs1KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT category.id,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[263] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getUnpublishedCategoryIds\n[668] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_categories` AS `category` LEFT JOIN `yzfp0_categories` AS `parent` ON `category`.`parent_id` = `parent`.`id` WHERE `category`.`extension` = 'com_content' AND (category.published IN (0,-1,-2) OR parent.published IN (0,-1,-2)) GROUP BY category.id210μs896B/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[840] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getArticleIdsByFilters\n[324] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE ((`article`.`state` = 1 AND (`article`.`publish_up` IS NULL OR `article`.`publish_up` <= '2024-12-03 01:09:58') AND (`article`.`publish_down` IS NULL OR `article`.`publish_down` = '0000-00-00 00:00:00' OR `article`.`publish_down` > '2024-12-03 01:09:58')) AND article.access IN (1,5) AND article.language IN ('es-ES','*')) AND `article`.`id` = 643137μs912B/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`title` AS `article.title`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[846] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 ORDER BY `article`.`title` IS NULL, CAST(`article`.`title` AS CHAR(1)) = '', CAST(`article`.`title` AS CHAR(10)) = '0000-00-00', CAST(`article`.`title` AS SIGNED INTEGER) = 0, CAST(`article`.`title` AS SIGNED INTEGER) ASC, `article`.`title` ASC LIMIT 1114μs1.06KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `alias` FROM `yzfp0_content` WHERE `id` = :id142μs1.63KBParams/components/com_content/src/Service/Router.php:168Copy
  • SELECT `alias` FROM `yzfp0_content` WHERE `id` = :id126μs1.63KBParams/components/com_content/src/Service/Router.php:168Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[846] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 ORDER BY `article`.`title` IS NULL, CAST(`article`.`title` AS CHAR(1)) = '', CAST(`article`.`title` AS CHAR(10)) = '0000-00-00', CAST(`article`.`title` AS SIGNED INTEGER) = 0, CAST(`article`.`title` AS SIGNED INTEGER) ASC, `article`.`title` ASC LIMIT 1176μs1KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`catid` AS `article.catid`,`category`.`id` AS `category.id`,`category`.`title` AS `category.title`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[846] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` LEFT JOIN `yzfp0_categories` AS `category` ON `category`.`id` = `article`.`catid` WHERE `article`.`id` = 643 ORDER BY `article`.`title` IS NULL, CAST(`article`.`title` AS CHAR(1)) = '', CAST(`article`.`title` AS CHAR(10)) = '0000-00-00', CAST(`article`.`title` AS SIGNED INTEGER) = 0, CAST(`article`.`title` AS SIGNED INTEGER) ASC, `article`.`title` ASC LIMIT 1169μs1.13KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `m`.`tag_id`,`t`.* FROM `yzfp0_contentitem_tag_map` AS `m` INNER JOIN `yzfp0_tags` AS `t` ON `m`.`tag_id` = `t`.`id` WHERE `m`.`type_alias` = :contentType AND `m`.`content_item_id` = :id AND `t`.`published` = 1 AND `t`.`access` IN (:preparedArray1,:preparedArray2)372μs5.23KBParams/libraries/src/Helper/TagsHelper.php:388Copy
  • SELECT `m`.`tag_id`,`t`.* FROM `yzfp0_contentitem_tag_map` AS `m` INNER JOIN `yzfp0_tags` AS `t` ON `m`.`tag_id` = `t`.`id` WHERE `m`.`type_alias` = :contentType AND `m`.`content_item_id` = :id AND `t`.`published` = 1 AND `t`.`access` IN (:preparedArray1,:preparedArray2)310μs5.23KBParams/libraries/src/Helper/TagsHelper.php:388Copy
  • SELECT `c2`.`language`,`c2`.`id` FROM `yzfp0_menu` AS `c` INNER JOIN `yzfp0_associations` AS `a` ON `a`.`id` = `c`.`id` AND `a`.`context` = :context INNER JOIN `yzfp0_associations` AS `a2` ON `a`.`key` = `a2`.`key` INNER JOIN `yzfp0_menu` AS `c2` ON `a2`.`id` = `c2`.`id` WHERE `c`.`id` = :id256μs1.69KBParams/libraries/src/Language/Associations.php:145Copy
  • SELECT `article`.`id` AS `article.id`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[779] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 LIMIT 1176μs8.89KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT * FROM `yzfp0_fields` AS `a` WHERE a.state IN (:preparedArray1,:preparedArray2) AND `a`.`context` = 'com_content.article'432μs54.11KBParams/plugins/system/articlesanywhere/src/DataGroups/Helpers/Fields.php:105Copy
  • SELECT *,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[590] RegularLabs.Plugin.System.ArticlesAnywhere.DataGroups.Field.getFieldFromDatabase\n[770] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_fields` AS `field` WHERE field.context = 'com_content.article' AND `field`.`name` = 'dms3-content-type'274μs4.09KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT value.item_id,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[443] RegularLabs.Plugin.System.ArticlesAnywhere.DataGroups.Field.getWhere\n[670] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_fields_values` AS `value` INNER JOIN `yzfp0_fields` AS `field` ON `field`.`id` = `value`.`field_id` WHERE `field`.`name` = 'dms3-content-type' AND `field`.`state` = 1 AND `field`.`context` = 'com_content.article' AND `value`.`value` = 'dms3_article'3.11ms484.88KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[727] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getArticleIdsByFilters\n[324] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` LEFT JOIN `yzfp0_fields` AS `field-dms3-content-type` ON `field-dms3-content-type`.`name` = 'dms3-content-type' AND `field-dms3-content-type`.`state` = 1 AND `field-dms3-content-type`.`context` = 'com_content.article' LEFT JOIN `yzfp0_fields_values` AS `field_value-dms3-content-type` ON `field_value-dms3-content-type`.`field_id` = `field-dms3-content-type`.`id` AND `field_value-dms3-content-type`.`item_id` = article.id WHERE ((`article`.`state` = 1 AND (`article`.`publish_up` IS NULL OR `article`.`publish_up` <= '2024-12-03 01:09:58') AND (`article`.`publish_down` IS NULL OR `article`.`publish_down` = '0000-00-00 00:00:00' OR `article`.`publish_down` > '2024-12-03 01:09:58')) AND article.access IN (1,5) AND article.language IN ('es-ES','*')) AND article.id IN 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  • SELECT `article`.`id` AS `article.id`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[757] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getArticleIdsByArticleIds\n[301] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` IN (1259,3,4,5,6,7,8,9,10,11,12,13,15,16,21,22,23,31,36,37,1288,1287,1286,1279,1278,1277,1276,1303,261,1315,260,753,1053,1272,242,241,240,239,230,229,228,227,226,225,214,213,212,211,210,1309,1310,1311,1314,1322,1323,1324,1331,1332,1335,1298,1297,1293,1292,1291,1290,1265,1264,1263,1262,1258,1257,1256,1255,1251,1244,1234,1230,1229,1227,1224,1223,1222,1220,1214,1212,1211,1210,1209,1208,1207,1206,1205,1204,1199,1195,1190,1185,1184,1179,1178,1174,1165,1164,1163,1159,1158,1157,1156,1154,1153,1152,1151,1149,1148,1147,1144,1139,1138,1137,1135,1123,1119,1118,1117,1116,1115,1113,1107,1105,1104,1098,1097,1096,1095,1094,1091,1084,1083,1082,1081,1076,1075,1074,1073,1072,1066,1065,1060,1057,1052,1047,1046,1045,1044,1043,1037,1033,1032,1031,1027,1025,1024,1022,1020,1019,1016,1012,1010,1008,1007,1004,1003,1000,995,992,984,979,977,976,975,974,973,972,971,970,969,968,967,966,965,964,963,962,961,949,938,935,934,933,927,926,925,923,919,918,917,916,914,908,906,905,904,903,899,897,892,890,884,883,882,881,880,878,877,873,862,861,860,857,856,852,850,849,848,838,837,836,835,833,831,830,829,828,823,821,805,804,803,801,800,799,798,797,793,792,791,790,789,780,779,778,767,55,755,754,752,751,750,749,748,747,746,744,743,742,741,737,735,734,731,729,723,719,718,717,712,711,710,708,707,706,704,689,686,685,683,676,675,672,671,666,665,664,649,648,647,643,642,637,634,633,629,628,622,621,614,613,608,605,604,603,602,561,560,556,547,543,542,540,535,528,520,519,518,509,508,506,505,503,502,484,483,482,479,477,476,460,459,458,457,455,454,453,452,450,433,432,431,430,429,423,422,421,420,413,412,411,410,403,402,401,399,385,384,383,382,381,376,375,374,373,372,371,370,369,361,360,359,358,356,354,353,352,351,350,276,275,274,273,272,271,270,264,54,59,60,253,345,344,339,333,332,331,322,321,320,319,318,317,316,315,314,308,307,305,300,299,298,287,286,285,587,584,572,183,182,181,178,177,175,171,170,169,164,163,161,1261,847,846,1317,1260,663,607,570,569,567,566,565,564,563,562,493,492,491,438,437,436,435,434,283,258,256,255,254,184,174,173,172,166,165,160,159,158,149,148,147,139,138,137,136,134,133,132,131,130,124,121,119,116,115,113,2586,2589,2590,2591,2592,2594,2595,2596,2598,2599,2600,2605,2611,2612) ORDER BY `article`.`hits` IS NULL, CAST(`article`.`hits` AS CHAR(1)) = '', CAST(`article`.`hits` AS CHAR(10)) = '0000-00-00', CAST(`article`.`hits` AS SIGNED INTEGER) = 0, CAST(`article`.`hits` AS SIGNED INTEGER) DESC, `article`.`hits` DESC LIMIT 32.86ms944B/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`title` AS `article.title`,`article`.`alias` AS `article.alias`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[765] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` IN (320,344,211) ORDER BY FIELD(article.id,320,344,211)261μs1.16KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`640μs5.22KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`494μs5.23KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`454μs5.23KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `alias` FROM `yzfp0_content` WHERE `id` = :id169μs1.63KBParams/components/com_content/src/Service/Router.php:168Copy
  • SELECT `alias` FROM `yzfp0_content` WHERE `id` = :id141μs1.63KBParams/components/com_content/src/Service/Router.php:168Copy
  • SELECT `article`.`id` AS `article.id`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[757] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getArticleIdsByArticleIds\n[301] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` LEFT JOIN `yzfp0_fields` AS `field-dms3-shares` ON `field-dms3-shares`.`name` = 'dms3-shares' AND `field-dms3-shares`.`state` = 1 AND `field-dms3-shares`.`context` = 'com_content.article' LEFT JOIN `yzfp0_fields_values` AS `field_value-dms3-shares` ON `field_value-dms3-shares`.`field_id` = `field-dms3-shares`.`id` AND `field_value-dms3-shares`.`item_id` = article.id WHERE `article`.`id` IN (1259,3,4,5,6,7,8,9,10,11,12,13,15,16,21,22,23,31,36,37,1288,1287,1286,1279,1278,1277,1276,1303,261,1315,260,753,1053,1272,242,241,240,239,230,229,228,227,226,225,214,213,212,211,210,1309,1310,1311,1314,1322,1323,1324,1331,1332,1335,1298,1297,1293,1292,1291,1290,1265,1264,1263,1262,1258,1257,1256,1255,1251,1244,1234,1230,1229,1227,1224,1223,1222,1220,1214,1212,1211,1210,1209,1208,1207,1206,1205,1204,1199,1195,1190,1185,1184,1179,1178,1174,1165,1164,1163,1159,1158,1157,1156,1154,1153,1152,1151,1149,1148,1147,1144,1139,1138,1137,1135,1123,1119,1118,1117,1116,1115,1113,1107,1105,1104,1098,1097,1096,1095,1094,1091,1084,1083,1082,1081,1076,1075,1074,1073,1072,1066,1065,1060,1057,1052,1047,1046,1045,1044,1043,1037,1033,1032,1031,1027,1025,1024,1022,1020,1019,1016,1012,1010,1008,1007,1004,1003,1000,995,992,984,979,977,976,975,974,973,972,971,970,969,968,967,966,965,964,963,962,961,949,938,935,934,933,927,926,925,923,919,918,917,916,914,908,906,905,904,903,899,897,892,890,884,883,882,881,880,878,877,873,862,861,860,857,856,852,850,849,848,838,837,836,835,833,831,830,829,828,823,821,805,804,803,801,800,799,798,797,793,792,791,790,789,780,779,778,767,55,755,754,752,751,750,749,748,747,746,744,743,742,741,737,735,734,731,729,723,719,718,717,712,711,710,708,707,706,704,689,686,685,683,676,675,672,671,666,665,664,649,648,647,643,642,637,634,633,629,628,622,621,614,613,608,605,604,603,602,561,560,556,547,543,542,540,535,528,520,519,518,509,508,506,505,503,502,484,483,482,479,477,476,460,459,458,457,455,454,453,452,450,433,432,431,430,429,423,422,421,420,413,412,411,410,403,402,401,399,385,384,383,382,381,376,375,374,373,372,371,370,369,361,360,359,358,356,354,353,352,351,350,276,275,274,273,272,271,270,264,54,59,60,253,345,344,339,333,332,331,322,321,320,319,318,317,316,315,314,308,307,305,300,299,298,287,286,285,587,584,572,183,182,181,178,177,175,171,170,169,164,163,161,1261,847,846,1317,1260,663,607,570,569,567,566,565,564,563,562,493,492,491,438,437,436,435,434,283,258,256,255,254,184,174,173,172,166,165,160,159,158,149,148,147,139,138,137,136,134,133,132,131,130,124,121,119,116,115,113,2586,2589,2590,2591,2592,2594,2595,2596,2598,2599,2600,2605,2611,2612) ORDER BY `field_value-dms3-shares`.`value` IS NULL, CAST(`field_value-dms3-shares`.`value` AS CHAR(1)) = '', CAST(`field_value-dms3-shares`.`value` AS CHAR(10)) = '0000-00-00', CAST(`field_value-dms3-shares`.`value` AS SIGNED INTEGER) = 0, CAST(`field_value-dms3-shares`.`value` AS SIGNED INTEGER) DESC, `field_value-dms3-shares`.`value` DESC LIMIT 3468ms944B/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`title` AS `article.title`,`article`.`alias` AS `article.alias`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[765] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` IN (543,1314,354) ORDER BY FIELD(article.id,543,1314,354)348μs1.16KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `c`.`id`,`c`.`asset_id`,`c`.`access`,`c`.`alias`,`c`.`checked_out`,`c`.`checked_out_time`,`c`.`created_time`,`c`.`created_user_id`,`c`.`description`,`c`.`extension`,`c`.`hits`,`c`.`language`,`c`.`level`,`c`.`lft`,`c`.`metadata`,`c`.`metadesc`,`c`.`metakey`,`c`.`modified_time`,`c`.`note`,`c`.`params`,`c`.`parent_id`,`c`.`path`,`c`.`published`,`c`.`rgt`,`c`.`title`,`c`.`modified_user_id`,`c`.`version`, CASE WHEN CHAR_LENGTH(`c`.`alias`) != 0 THEN CONCAT_WS(':', `c`.`id`, `c`.`alias`) ELSE `c`.`id` END as `slug` FROM `yzfp0_categories` AS `s` INNER JOIN `yzfp0_categories` AS `c` ON (`s`.`lft` < `c`.`lft` AND `c`.`lft` < `s`.`rgt` AND `c`.`language` IN (:preparedArray3,:preparedArray4)) OR (`c`.`lft` <= `s`.`lft` AND `s`.`rgt` <= `c`.`rgt`) WHERE (`c`.`extension` = :extension OR `c`.`extension` = 'system') AND `c`.`access` IN (:preparedArray1,:preparedArray2) AND `c`.`published` = 1 AND `s`.`id` = :id ORDER BY `c`.`lft`438μs5.22KBParams/libraries/src/Categories/Categories.php:375Copy
  • SELECT `a`.`id`,`a`.`asset_id`,`a`.`title`,`a`.`alias`,`a`.`introtext`,`a`.`fulltext`,`a`.`state`,`a`.`catid`,`a`.`created`,`a`.`created_by`,`a`.`created_by_alias`,`a`.`modified`,`a`.`modified_by`,`a`.`checked_out`,`a`.`checked_out_time`,`a`.`publish_up`,`a`.`publish_down`,`a`.`images`,`a`.`urls`,`a`.`attribs`,`a`.`version`,`a`.`ordering`,`a`.`metakey`,`a`.`metadesc`,`a`.`access`,`a`.`hits`,`a`.`metadata`,`a`.`featured`,`a`.`language`,`fp`.`featured_up`,`fp`.`featured_down`,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`language` AS `category_language`,`fp`.`ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,`parent`.`language` AS `parent_language`,ROUND(`v`.`rating_sum` / `v`.`rating_count`, 1) AS `rating`,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_content_frontpage` AS `fp` ON `fp`.`content_id` = `a`.`id` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `a`.`id` = `v`.`content_id` WHERE ( (`a`.`id` = :pk AND `c`.`published` > 0 AND `a`.`language` IN (:preparedArray1,:preparedArray2)) AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= :publishUp)) AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` >= :publishDown) AND `a`.`state` IN (:preparedArray3,:preparedArray4)598μs104.73KBParams/components/com_content/src/Model/ArticleModel.php:215Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`title` AS `article.title`,`article`.`alias` AS `article.alias`,`article`.`catid` AS `article.catid`,`article`.`language` AS `article.language`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[846] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 ORDER BY `article`.`title` IS NULL, CAST(`article`.`title` AS CHAR(1)) = '', CAST(`article`.`title` AS CHAR(10)) = '0000-00-00', CAST(`article`.`title` AS SIGNED INTEGER) = 0, CAST(`article`.`title` AS SIGNED INTEGER) ASC, `article`.`title` ASC LIMIT 1189μs1.13KB/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT `article`.`id` AS `article.id`,`article`.`hits` AS `article.hits`,'https://recintervcardiol.org/es/enfermedad-valvular/tratamiento-antiagregante-plaquetario-unico-o-doble-tras-implante-percutaneo-de-valvula-aortica-metanalisis-de-ensayos-clinicos-aleatorizados-2\n[846] RegularLabs.Plugin.System.ArticlesAnywhere.Articles.getValuesByArticleIds\n[828] RegularLabs.Plugin.System.ArticlesAnywhere.Database.getResults\n[103] RegularLabs.Plugin.System.ArticlesAnywhere.Helpers.DB.__callStatic' as 'query_comment' FROM `yzfp0_content` AS `article` WHERE `article`.`id` = 643 ORDER BY `article`.`title` IS NULL, CAST(`article`.`title` AS CHAR(1)) = '', CAST(`article`.`title` AS CHAR(10)) = '0000-00-00', CAST(`article`.`title` AS SIGNED INTEGER) = 0, CAST(`article`.`title` AS SIGNED INTEGER) ASC, `article`.`title` ASC LIMIT 1157μs976B/plugins/system/articlesanywhere/src/Database.php:123Copy
  • SELECT * FROM `yzfp0_schemaorg` WHERE `itemId` = :itemId AND `context` = :context227μs1.86KBParams/plugins/system/schemaorg/src/Extension/Schemaorg.php:411Copy
  • SELECT `a`.`id`,`a`.`asset_id`,`a`.`title`,`a`.`alias`,`a`.`introtext`,`a`.`fulltext`,`a`.`state`,`a`.`catid`,`a`.`created`,`a`.`created_by`,`a`.`created_by_alias`,`a`.`modified`,`a`.`modified_by`,`a`.`checked_out`,`a`.`checked_out_time`,`a`.`publish_up`,`a`.`publish_down`,`a`.`images`,`a`.`urls`,`a`.`attribs`,`a`.`version`,`a`.`ordering`,`a`.`metakey`,`a`.`metadesc`,`a`.`access`,`a`.`hits`,`a`.`metadata`,`a`.`featured`,`a`.`language`,`fp`.`featured_up`,`fp`.`featured_down`,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`language` AS `category_language`,`fp`.`ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,`parent`.`language` AS `parent_language`,ROUND(`v`.`rating_sum` / `v`.`rating_count`, 1) AS `rating`,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_content_frontpage` AS `fp` ON `fp`.`content_id` = `a`.`id` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `a`.`id` = `v`.`content_id` WHERE ( (`a`.`id` = :pk AND `c`.`published` > 0 AND `a`.`language` IN (:preparedArray1,:preparedArray2)) AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= :publishUp)) AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` >= :publishDown) AND `a`.`state` IN (:preparedArray3,:preparedArray4)405μs104.73KBParams/components/com_content/src/Model/ArticleModel.php:215Copy
  • SELECT SUM(CASE WHEN `a`.`next_execution` <= :now THEN 1 ELSE 0 END) AS due_count,SUM(CASE WHEN `a`.`locked` IS NULL THEN 0 ELSE 1 END) AS locked_count FROM `yzfp0_scheduler_tasks` AS `a` WHERE `a`.`state` = 1181μs1.68KBParams/administrator/components/com_scheduler/src/Model/TasksModel.php:466Copy
  • SELECT r.* FROM yzfp0_rereplacer AS r WHERE r.published = 1 AND (r.area = 'head' OR r.params LIKE '%\"use_xml\":\"1\"%') ORDER BY r.ordering, r.id386μs2.14KB/plugins/system/rereplacer/src/Items.php:97Copy
  • SELECT m.condition_id,m.item_id FROM yzfp0_conditions_map as m LEFT JOIN yzfp0_conditions as c ON c.id = m.condition_id WHERE `m`.`extension` = 'com_rereplacer' AND `c`.`published` = 1268μs896B/administrator/components/com_conditions/src/Model/ItemModel.php:815Copy
  • SELECT r.* FROM yzfp0_rereplacer AS r WHERE r.published = 1 AND (r.area = 'body' OR r.params LIKE '%\"use_xml\":\"1\"%') ORDER BY r.ordering, r.id315μs18.42KB/plugins/system/rereplacer/src/Items.php:97Copy
  • SELECT `value` FROM `yzfp0_fields_values` WHERE `item_id` = '643' AND `field_id` = 30359μs840B/tmp/regularlabs/custom_php/9234_af27ee991d0d77889539c6cba39057bf:36Copy
  • SELECT `value` FROM `yzfp0_fields_values` WHERE `item_id` = '643' AND `field_id` = 19213μs856B/tmp/regularlabs/custom_php/9234_af27ee991d0d77889539c6cba39057bf:61Copy
  • SELECT a.id,a.asset_id,a.title,a.alias,a.introtext,a.fulltext,a.state,a.catid,a.created,a.created_by,a.created_by_alias,CASE WHEN a.modified = '0000-00-00 00:00:00' THEN a.created ELSE a.modified END as modified,a.modified_by,a.checked_out,a.checked_out_time,a.publish_up,a.publish_down,a.images,a.urls,a.attribs,a.version,a.ordering,a.metakey,a.metadesc,a.access,a.hits,a.metadata,a.featured,a.language,`c`.`title` AS `category_title`,`c`.`alias` AS `category_alias`,`c`.`access` AS `category_access`,`c`.`lft` AS `category_lft`,`c`.`lft` AS `category_ordering`,`u`.`name` AS `author`,`parent`.`title` AS `parent_title`,`parent`.`id` AS `parent_id`,`parent`.`path` AS `parent_route`,`parent`.`alias` AS `parent_alias`,ROUND(v.rating_sum / v.rating_count, 0) AS rating,`v`.`rating_count` AS `rating_count` FROM `yzfp0_content` AS `a` INNER JOIN `yzfp0_categories` AS `c` ON `c`.`id` = `a`.`catid` LEFT JOIN `yzfp0_users` AS `u` ON `u`.`id` = `a`.`created_by` LEFT JOIN `yzfp0_categories` AS `parent` ON `parent`.`id` = `c`.`parent_id` LEFT JOIN `yzfp0_content_rating` AS `v` ON `v`.`content_id` = `a`.`id` WHERE `a`.`id` = 643 AND `c`.`published` > 0 AND (`a`.`state` = 1 AND (`a`.`publish_up` IS NULL OR `a`.`publish_up` <= '2024-12-03 01:09:58') AND (`a`.`publish_down` IS NULL OR `a`.`publish_down` = '0000-00-00 00:00:00' OR `a`.`publish_down` > '2024-12-03 01:09:58'))485μs103.44KB/libraries/regularlabs/src/Article.php:94Copy
  • SELECT `value` FROM `yzfp0_fields_values` WHERE `field_id` = 18 AND `item_id` = 6432ms856B/tmp/regularlabs/custom_php/9234_20d16d1e6db57666571c51c2623628e6:28Copy
  • SELECT r.* FROM yzfp0_rereplacer AS r WHERE r.published = 1 AND (r.area = 'everywhere' OR r.params LIKE '%\"use_xml\":\"1\"%') ORDER BY r.ordering, r.id331μs2.19KB/plugins/system/rereplacer/src/Items.php:97Copy
  • SELECT `session_id` FROM `yzfp0_session` WHERE `session_id` = ?215μs1.63KBParams/libraries/vendor/joomla/session/src/Handler/DatabaseHandler.php:277Copy
  • UPDATE `yzfp0_session` SET `data` = ? , `time` = ? WHERE `session_id` = ?614μs912BParams/libraries/vendor/joomla/session/src/Handler/DatabaseHandler.php:301Copy
  • infoplg_system_j2xml - plgSystemJ2xml::__construct
  • infoplg_system_basicauth - plgSystemBasicauth::__construct
  • infoplg_system_basicauth - PHP_SAPI: fpm-fcgi
  • infoplg_system_basicauth - authorization:
  • infoplg_system_basicauth - plgSystemBasicauth::onAfterRoute
  • infoplg_system_j2xml - plgSystemJ2xml::onAfterDispatch
  • infoplg_system_basicauth - plgSystemBasicauth::onBeforeRender