Aim Rotational atherectomy (RA) is routinely used to treat calcified lesions during percutaneous coronary intervention (PCI), however, PCI related myocardial infarction (PMI) is found in some patients. This study aimed to explore the predictive factors for PMI in patients undergoing RA. Methods 198 patients enrolled in the present study were divided into two groups according to the occurrence of PMI after RA. All the patients received RA prior to drug-eluting stent implantation in severely calcified lesions. The differences of demographic characteristics, hematological profiles, echocardiography parameters and interventional characteristics were compared between the two groups. Predictors for PMI after RA were evaluated using univariable and multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the independent factors. Results Syntax scores, diabetes, family history, low density lipoprotein cholesterol and slow flow were independently associated with PMI in patients undergoing RA. Combined use of these variables provided incremental predictive value for PMI after RA, and the area under the curve was 0.832 with 0.731 sensitivity and 0.823 specificity. Conclusion Syntax scores was an independent predictor for PMI after drug-eluting stent implantation following RA. In addition, combination of diabetes, family history, low density lipoprotein cholesterol and slow flow provided additional predictive value for PMI after RA than Syntax scores alone.