Background: Smoking was the third largest contributors to the disability adjusted life years (dalys) attributable to Acute Coronary Syndrome (ACS) worldwide. The aim of this study was to assess the burden benefits from smoking cessation in patients with ACS. Methods: A longitudinal observational study among ACS inpatients attending the smoking cessation clinic between 2015 and 2018 at the university hospital of Monastir. Cox models were used to quantify the relation between smoking status and risk of recurrent Major Adverse Cardiac Events (MACES). DALYS were calculated by the Sum of Years of Life Lost (YLLS) and Years Lived with Disability (YLDS). Results: The quarter of 158 smokers stopped after their first ACS. Twelve died and 91 maces occurred. Compared to patients who continued to smoke, ex-smokers had a lower risk of recurrent maces (adjusted HR=0.56; 95%ci (0.32-0.98)). After the fifth year of follow up the adjusted HR was of 0.31; 95% ci (0.88-1.11). DALYS were greater in persistent smokers. Conclusions: Continuing smoking was associated with large numbers of DALYS after ACS. However, the success of smoking cessation remains minimal in these patients. Thus, our findings lend additional support to efforts that encourage smoking cessation in patients with or without cardiovascular events.