Aim To assess the association between partners’ smoking status and acute coronary syndrome in never smokers in Albania. Methods This population-based case-control study was conducted in Tirana in the period 2003-2006. It involved 467 consecutive patients with non-fatal acute coronary syndrome and 737 controls. Only married never-smokers (169 patients with acute coronary syndrome and 323 controls) were included in the analysis. Information on socioeconomic status, coronary risk factors, and partners’ current smoking status was obtained by a structured questionnaire. Multivariate logistic regression was used to assess the association between partner’s smoking status and acute coronary syndrome. Results Among patients with acute coronary syndrome, 49% of women and 25% of men had a partner who was a current smoker, as opposed to 44% of women and 16% of men in the control group. In age-adjusted models, non-smoking men with smoking partners had a greater acute coronary syndrome risk (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.98-3.18), while no association was found in women with smoking partners (OR, 1.05; 95% CI, 0.48-2.30). After adjustment for socioeconomic characteristics, coronary risk factors, and psychosocial factors, the acute coronary syndrome risk in men was somewhat lower (1.68; 95% CI, 0.81-3.47), while for women it was somewhat greater but still nonsignificant (1.19; 95% CI, 0.25-5.64). Sex-pooled estimate of the risk was OR 1.64 (95% CI, 0.96-2.83). Conclusion Partner’s current smoking status was positively associated with a greater acute coronary syndrome risk in men but not in women, both before and after adjustment for socioeconomic characteristics and coronary risk factors. Programs aimed at reducing the exposure to passive smoking are need in countries with high prevalence of active smoking.