Background: We investigated the prognostic value of pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow for major adverse cardiac events (MACE) and cardiovascular death (CVD) using Korean registry data in ST-elevation myocardial infarction patients underwent primary percutaneous coronary intervention. Methods: Between October of 2005 and May of 2013, a total of 16,843 patients were registered. Of these, 8,428 patients (mean age 62.8 years) were enrolled. Depending on pre-procedural TIMI flow, we divided into 2 groups by TIMI flow 0-2 vs. 3. Results: During follow-up (median 350 days), 938 (11.1%) of MACE and 488 (5.8%) CVD occurred. Preprocedural TIMI 3 flow group showed high event rates in ≤ 30 day MACE (3.5% vs. 5.9% p = 0.001), ≤ 30 day CVD (2.4% vs. 4.8%, p = 0.001), 1-year MACE (9.4% vs. 11.4% p = 0.047) and 1-year CVD (3.8% vs. 6.1% p = 0.002). In the multivariate Cox regression analysis, pre-procedural TIMI 0-2 flow was not an independent predictor of ≤ 30 day MACE, ≤ 30 CVD, 1-year MACE, and 1-year CVD. Conclusion: The pre-procedural TIMI 0-2 flow is not independent predictor of ≤ 30 day MACE and ≤ 30 day CVD, 1-year MACE, and 1-year CVD.