The number of admissions for acute coronary syndrome (ACS) for the 10-month period preceding enactment of national smoke-free legislation in March 2006 in Scotland was compared with admissions during the 10-month period after enactment, overall and according to smoking status. Overall, the number of admissions for ACS decreased from 3235 to 2684 (by 17%), as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. This reduction could not be attributed to the number of patients who were not hospitalised and who died from ACS; this number decreased by 6%, from 2202 patients during the period 2005 through 2006 to 2080 patients during the period 2006 through 2007. The number of admissions for acute coronary syndrome was reduced by 14% among smokers, by 19% among former smokers, and by 21% among never-smokers. Among never-smokers, self-reported reductions in exposure to smoke were confirmed by a reduction in the geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per mL.
