Objective To investigate the effects of electrocardiographic synchronization control based enhanced external counterpulsation (EECP) engineering system combined with Tongxinluo capsule on myocardial biomarkers in patients with acute coronary syndrome (ACS). Methods A total of 100 ACS patients admitted to the Department of Cardiovascular, Luohe Second People’s Hospital from January 2023 to December 2023 were included, and were divided into the control group and the observation group by the method of a random number table, with 50 cases in each group. The control group was given Tongxinluo capsules treatment, and the observation group was given EECP and Tongxinluo capsules combined treatment. The clinical efficacy, cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitivity C-reactive protein (hs-CRP) expression levels before and after the treatment were compared between the two groups, and the incidence of adverse reactions was also counted. Results The clinical efficacy of the observation group was significantly better than that of the control group, with an effective rate as high as 98%, while the effective rate of the control group was only 82% (P<0.05). Before the treatment, there was no significant difference in the levels of cTnI, NT-pro-BNP, and hs-CRP between the observation and control groups (P >0.05). However, after the treatment, the clinical symptoms of patients in both groups improved, and the improvement was more significant in the observation group (P<0.05). After treatment, the levels of cTnI, NT-pro-BNP, and hs-CRP in both groups was reduced compared with those before treatment (all P<0.05), with a more significant reduction in the observation group. Meanwhile, the incidence rates of adverse reactions in the observation group and the control group was 2.00% and 14.00% respectively, with significant differences between the two groups (P<0.05). Conclusion The EECP engineering system based on electrocardiographic synchronization control combined with Tongxinluo capsule has obvious clinical efficacy in patients with ACS, and reduces the expression levels of myocardial injury biomarkers of cTnI, NT-pro-BNP and hs-CRP, and has high safety, which is suitable for clinical promotion and application.