-sarutobi still alive-
-could've aided jiraiya against pain-
-if he died by pain, it wouldn't be from ninja aids-
- possibility of kakashi not wasting his chakra(dies) against deva path.
-sasuke protects kohona sooner(volunteer or kotoamatsukami)
anything is possible. kohona would've had a MUCH greater chance of fighting off enemies with itachi rather than tsunade.
I consider him worthy of the position too i'm also wondering how people think his reign as Hokage would have affected the rest of the characters.
It's unknown. the only thing i'm certain of is that the elders, 3rd, kakashi and naruto would've still respected itachi. that i'm certain