Aim Circulating visfatin levels has reflected the long-term survival in patients with ST-elevation myocardial infarction (STEMI). It postulated that higher visfatin would be linked to increased risk for atrial fibrillation (AF) and major adverse cardiovascular events (MACE) in patients with STEMI treated with primary percutaneous coronary intervention (PPCI). Methods 604 patients with acute STEMI underwent the PPCI were enrolled in the study. ELISA was used to measure plasma visfatin concentrations. One-year MACE and adverse events were compared between patients with and without new-onset AF after PPCI, and statistical analysis was used to respectively analyze the relationship between plasma visfatin level and MACE, plasma visfatin level and new-onset AF. Results From statistical data we learned that 42 of these patients had the new-onset AF (6.95%). The incidence rate of MACE in patients with new-onset AF was higher than patients without AF after PPCI within one year (45.24% vs 19.57%, P<0.05). Moreover, compared with patients with low plasma visfatin levels (≤14.5 μg/L), the patients with higher plasma visfatin levels (＞14.5 μg/L) had high rates of MACE (31.02% vs 9.56%, P<0.001) and new-onset AF (10.24% vs 2.94%, P<0.001). The multivariate Cox hazard regression model revealed that the plasma visfatin level was an independent predictor for occurrence of new-onset AF after PPCI one year (hazard ratio (HR) was 1.51, and 95% confidence interval (CI) was 1.03 to 2.23, P=0.021). Conclusion Plasma visfatin levels have a positive correlation with the incidence rate of new-onset AF and connection with MACE in patients with acute STEMI treated with PPCI.