Background: Epicardial infarct-related artery patency is reliably assessed by the Thrombolysis In Myocardial Infarction (TIMI) flow grade (TFG), and this index of flow is associated with clinical outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to determine the long-term clinical and angiographic outcomes according to the pre-procedural TFG in patients with AMI after percutaneous coronary intervention (PCI). Methods: A total of 132 patients with AMI who underwent PCI between July 2001 and December 2001 were divided into two groups according to the pre-procedural TFG: Group I (n=60, 62.7짹9.2 years, male 66.7%) with TFG 0-1 and Group II (n=72, 61.6짹11.1 years, male 68.1%) with TFG 2-3. Results: Hypertension was more prevalent in Group I (56.7% vs. 27.8%, p=0.001) and cardiogenic shock on admission was more frequently observed in Group I (20.0% vs. 5.6%, p=0.011). The left ventricular ejection fraction was lower in Group I (42.6짹10.5% vs. 50.5짹12.1%, p=0.022). During 1-year clinical follow-up, the mortality was higher in Group I than that in Group II (10.0% vs. 1.4%, p=0.028), however, there were no significant differences in the incidences of restenosis and target lesion revascluarization between both groups. The event-free survival rate was lower in Group I than that in Group II (60.0% vs. 79.2%, p=0.016). The independent predictors for major adverse cardiac events were cardiogenic shock, CRP ��� 0.5 mg/dL, age ��� 70 years, triple vessel disease, pre-interventional TFG 0-1, post-interventional TFG 0-2. Conclusion: Low pre-procedural TFG is associated with higher incidences of hypertension, cardiogenic shock, and LV dysfunction, and higher rate of mortality, and lower event-free survival during one-year clinical follow-up after PCI in patients with AMI.