In combination with counseling, nicotine replacement ther- apy can be an important adjunctive strategy to help achieve smoking cessation. In a randomized trial of 5887 smokers, long-term rates of smoking and mortality were reduced with the application of a 10-week smoking cessation program that included a strong physician message, nicotine gum, and 12 group sessions using behavior modification.304 On the basis of a systematic review of the literature in 2008, the US Public Health Service advocated the use of 5 nicotine replacement medications (gum, patch, nasal spray, inhaler, and lozenge) and reported that the combination of a long-term nicotine patch and ad lib nicotine spray or gum produced significantly higher long-term abstinence rates than did the nicotine patch Compared with nicotine replacement medications, electronic cigarettes (e-cigarettes) have not been demonstrated to improve smoking cessation rates, and important concern has been raised about their potential for adverse health effects.306 Nicotine replacement therapy has been shown to be safe for patients with stable CAD. In a randomized, double-blind, pla- cebo-controlled trial, a 10-week outpatient course of transder- mal nicotine did not increase the rate of cardiovascular events among patients with at least 1 diagnosis of cardiovascular dis- In hospitalized patients, nicotine replacement therapy is commonly used as an effective strategy to manage nicotine but less is known about the routine use of nicotine replacement therapy during an acute cardio- vascular event. 