Aim To investigate the correlation of epicardial adipose tissue (EAT), serum ischemia modified albumin (IMA) and high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute coronary syndrome (ACS). Methods 120 cases of ACS in our hospital from September 2014 to November 2015 were selected as the case group, including 40 cases in single vessel disease group, double vessel disease group and multiple vessel disease group. 120 cases with normal healthy cardiac function in our hospital physical examination were selected as the control group. EAT thickness was measured by echocardiography, IMA was measured by albumin cobalt ion combined with serum test, serum hs-cTnT levels were measured by electro chemiluminescence immunoassay. Results EAT thickness, IMA and hs-cTnT levels and Gensini scores in ACS patients were significantly higher than those in normal control group (P＜0.01). In ACS patients, the EAT thickness, IMA, hs-cTnT and Gensini score in single vessel disease group, double vessel disease group and multiple vessel disease group were all increased, and were higher than those in control group (P＜0.01). EAT thickness, IMA and hs-cTnT levels were significantly positively correlated with Gensini score (P＜0.01) in patients with ACS. IMA level of single vessel lesion group was correlated with Gensini score (P＜0.05), EAT thickness and hs-cTnT level had no significant correlation with Gensini score (P＞0.05). EAT thickness, IMA and hs-cTnT level were significantly positively correlated with Gensini score in double vessel group and multiple vessel disease group (P＜0.05 or P＜0.01). Conclusion EAT thickness, IMA and hs-cTnT levels were correlated with the severity of ACS lesions.