This study examined predictors of readiness to quit smoking among emergency chest pain patients admitted to the observation unit (OU) to rule out myocardial infarction. While in the OU, patients (n=543) completed surveys assessing smoking history, nicotine dependence, readiness to quit, and other relevant variables. Participants smoked an average of 18.8 (SD=12.6) cigarettes per day. More than half (58%) had made at least 1 serious quit attempt > or = 24 hours) in the past year. Most had never used nicotine replacement medications. Nicotine dependence, perceived risk from smoking, and patient perceptions that smoking might be related to their chest pain were significantly associated with readiness to quit (P<.05). Results indicate that a significant proportion of OU patients think they are at relatively low risk from smoking and, although motivated to quit, are not using medications appropriately to assist quit attempts. There is a need for intervention and education with this population of patients.