Objective To explore the influencing factors of intraoperative complications and short-term postoperative major adverse cardiovascular events (MACE) in rotational atherectomy (RA) among the elderly patients with coronary artery calcification (CAC). Methods From January 2017 to December 2020,188 elderly CAC patients who underwent RA in the Third People′s Hospital of Yibin were collected. The operation was performed according to the Chinese Expert Consensus on Rotational Atherectomy. The patients were followed up for MACEs for 12 months after operation and were divided into study group and control group based on the occurrence of MACEs within 12 months. SPSS 25.0 was used for statistical analysis. Comparison between groups was made using t-test or chi-square test according to the data type. Multivariate logistic regression was used to analyze the influencing factors of the intraoperative complications and postoperative MACE within 12 months. Results The incidence was 17.02% (32/188) for the intraoperative complications and 18.62% (35/188) for MACE within 12 months after the operation. There were statistically significant differences between MACE and non-MACE patients in body mass index, history of smoking, history of heart failure, history of hypertension, history of previous myocardial infarction, diseased vessels, SYNTAX score, prothrombin time, glycosylated hemoglobin A1c (HbA1c), minimum lumen diameter (MLD), cross section area (CSA), and ratio of rotary burr to vessel diameter (P<0.05 for all). Multivariate analysis showed that the history of heart failure, angiopathic vessels (double, triple vessels and left main branch compared with single vessel), SYNTAX score, MLD, and ratio of rotary burr to vessel diameter were the influencing factors of intraoperative complications[OR=0.518, (1.660,2.311 and 3.089), 3.893,0.794,0.641；all P<0.05]. The influencing factors of MACE within 12 months after operation were the history of heart failure, history of hypertension, SYNTAX score, HbA1c and MLD (OR=0.481,0.812,2.777,0.762,0.721；all P<0.05). Conclusion Complications of RA may be related to the history of heart failure, angiopathic vessel, SYNTAX score, MLD, and ratio of rotary burr to vessel diameter; the history of heart failure, history of hypertension, SYNTAX score, HbA1c and MLD may be independent predictors of short-term postoperative MACE.