Background: Acute myocardial infarction represents a major cause of heart failure, arrhythmia, and mortality in patients with coronary artery disease and impaired microvascular reperfusion is an important prognostic determinant in patients undergoing revascularization with either primary percutaneous coronary intervention (PCI) or pharmaco-invasive strategy after ST-segment elevation myocardial infarction (STEMI). Objective: The aim of the current work was to evaluate the outcome of patients presenting with acute ST-segment elevation myocardial infarction by determining the impact of correlation of QRS duration with myocardial blush grade of myocardium as a marker of myocardial reperfusion following revascularization procedures. Patients and Methods: This prospective cohort study was conducted at Cardiology Department, Zagazig University Hospitals and National Heart Institute. We included 119 patients with acute ST-segment elevation myocardial infarction undergoing revascularization. Patients were divided into two groups according to the reperfusion strategy. Group I: included 70 patients with primary percutaneous coronary intervention (PCI) and Group II: included 49 patients with pharmaco-invasive strategy. Results: Post catheter QRS duration of the studied patients was 82 msec, and it was significantly higher in group II (92 msec) than group I (74 msec) (P-value < 0.001). QRS duration 60 minutes post PCI was 83 msec, and it was significantly higher in group II (96 msec) than group I (73 msec) (P-value was < 0.001). The mean ST resolution was 51, and it was significantly higher in group I (61) than group II (36) (P-value < 0.001). Conclusions: It could be concluded that longer QRS duration after angioplasty seemed to indicate the presence of