Aim To explore the influential factors of slow flow following rotational atherectomy (RA) and the predictive value of these factors. Methods According to the presence or absence of slow flow (defined as transient thrombolysis in myocardial infarction (TIMI) flow grade ≤2 just after RA), a total of 219 cases undergoing RA were divided into slow flow group (n=50) and non-slow flow group (n=169). The clinical history, laboratory examinations, and coronary intervention data of the two groups were compared. The two-class Logistic regression model was used to analyze independent influential factors of slow flow, the operating characteristic (ROC) curve was used to evaluate the predictive value. Results There were 50 patients (22.8%) in the slow flow group. Compared with the non-slow flow group, the final burr size of 1.25 mm was more used in the slow flow group (P＜0.05), while the final burr size of 1.5 mm was fewer (P＜0.05); Lesion length and total run time were longer, rotation times were higher (P＜0.05); while systolic blood pressure was lower in the slow flow group, and reference diameter was significantly smaller (P＜0.05). The two-class Logistic regression analysis showed that lesion length was an independent risk factor for slow flow, while reference diameter and systolic blood pressure were preventive factors (P＜0.05). Combined use of these variables provided incremental predictive value for slow flow after RA procedure, and the area under the curve was 0.736 with 78.0% sensitivity and 65.1% specificity. Conclusion Lesion length was an independent risk factor of slow flow, while reference diameter and systolic blood pressure were preventive factors, and the combination of these variables provided additional predictive value for slow flow in patients undergoing RA.