Thrombolytic therapy for acute myocardial infarction: Gusto criticized

To the Editor: After an intensive marketing campaign by Genentech, the report by the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) investigators (Sept. 2 issue)¹ has finally appeared. In view of the small survival advantage conferred by tissue plasminogen activator (t-PA) (0.9 percent — an effect evident only when it is administered within four hours after the onset of symptoms), the increased risk of stroke, and the striking difference in the expense of therapy (a difference of $220,000 to save a single life: $2,300 - $320 × 100 divided by 0.9), the fact that.