Adding prescription smoking cessation medications to nicotine replacement therapy dramatically improved survival rates among heart attack survivors. This real-world analysis of 8,574 matched patient pairs found that combining drugs like bupropion or varenicline with nicotine patches reduced all-cause mortality by 26% at one year, alongside significant reductions in major cardiovascular events, heart failure episodes, and bleeding complications. The benefits were consistent across both individual medications, with patients also showing greater engagement in cardiac rehabilitation programs. These findings challenge current clinical practice, where prescription smoking cessation aids remain severely underutilized despite Class I recommendations for post-heart attack smoking cessation. The cardiovascular benefits likely stem from enhanced smoking cessation rates, though the study design prevents direct measurement of quit rates. While the large dataset provides robust real-world evidence, this propensity-matched observational study cannot establish causation, and potential confounding factors may influence outcomes. As a preprint awaiting peer review, these results require validation through randomized controlled trials. Nevertheless, the magnitude of benefit suggests a paradigm shift toward aggressive pharmacological smoking cessation support could substantially improve cardiovascular outcomes in this high-risk population.