Patient preferences for thrombolytic therapy in acute myocardial infarction.

Background. Despite extensive professional debate regarding the optimal thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored. Methods. Preferences among patients with known or suspected coro nary artery disease for treatment with tissue plasminogen activator (tPA) or streptoki nase (SK) for AMI were determined using a questionnaire presenting GUSTO-1 trial and drug cost data. Preferences were based on consideration of 30-day mortality (M) alone, hemorrhagic stroke rate (SR) alone, overall preference (M + SR), drug acqui sition costs, and the estimated annual costs of using a single agent to treat all AMIs. Cost-related responses were provided under payer designations of self, third-party insurance, and federal government. Results. The response rate was 81% (101/125 patients). tPA was preferred by 84%, and SK by 66%, for M alone and SR alone, respectively (χ 2, p < 0.01). Overall preference (M + SR) favored tPA (78%, p < 0.01). tPA preference decrea...