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Background/Introduction Elevated left ventricle end diastolic pressure (LVEDP) is related to diastolic dysfunction, increased retrograde pulmonary capillary pressure and pulmonary congestion. Diastolic dysfunction precedes the onset of systolic dysfunction in acute ischemia, and the prognostic utility of LVEDP in ST-segment elevation myocardial infarction (STEMI) is well known. Bedside lung ultrasound (LUS) is a simple and sensitive method for evaluating pulmonary congestion. Purpose The aim of this study was to assess the correlation between LVEDP and LUS and to evaluate their prognostic capacity in STEMI patients submitted to primary percutaneous coronary intervention (PPCI). Methods This was a prospective cohort of STEMI patients treated in a tertiary care hospital. LUS was performed by two independent operators before coronary angiography. Our protocol consisted of eight scanning zones; a zone was considered positive in case it presented three or more B lines. LVEDP was recorded before coronary angiography, assessed offline and blinded to LUS results. Results We have included 217 patients with mean age of 60 (±12.1) years and 63% were male. Killip 4 on admission was diagnosed in 16.5% of patients and total in-hospital mortality was 14.7%. Median LVEDP and LUS positive sites were 19 mmHg [13, 28] and 1 [0, 5], and spearman correlation between them was 0.33. LUS and LVEDP c-statistics for in-hospital mortality were 0.69 (0.58–0.79) and 0.60 (0.49–0.71), respectively. LUS and LVEDP c-statistics for in-hospital cardiogenic shock were 0.75 (0.67 – 0.83) and 0.65 (0.57–0.74), respectively. A multivariate analysis was performed including 4 or more positive LUS zones, LVEDP >22 mmHg, diabetes and admission creatinine. In patients with 4 or more positive LUS zones, odds ratios of cardiogenic shock and in-hospital mortality were 7.04 (2.89–18.30, p<0.001) and 4.52 (1.92–11.12, p=0.001), respectively. In patients with LVEDP higher than 22 mmHg, odds ratios for cardiogenic shock and in-hospital mortality were 1.43 (0.57–3.54, p=0.437) and 0.88 (0.36–2.09, p=0.768), respectively. Conclusion We found no significant correlation between LVEDP and LUS in a STEMI patient's cohort. Unlike LVEDP, LUS had a significant AUC to predict in-hospital mortality. LUS had a great magnitude hazard ratio for cardiogenic shock and in-hospital mortality when 4 or more scanning zones were positive. A high LVEDP did not predict cardiogenic shock or in-hospital mortality on this subset of STEMI patients. LUS and LVEDP correlation Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Hospital de Clinicas de Porto Alegre and Universidade Federal do Rio Grande do Sul