Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods One hundred and ninety five patients with AMI undergone primary PCI were randomized into two groups using different catheter insertion pathways: 105 cases by transfemoral approach and 90 cases by transradial approach. We compared data of different operating approaches in terms of success rate of access, cannulation time, the time from local anesthesia to the first balloon inflation, the total procedure time, success rate of PCI, access site complications, total duration of hospitalization, and the clinical outcomes at six-month follow-up. Results The success rate of artery puncture, cannulation time, and the time from local anesthesia to the first balloon inflation in the transradial and transfemoral groups were 98.9 % vs 100 % (P>0.05), 3.15± 1.56 minutes vs 2.86± 0.97 minutes (P>0.05), and 18.56± 4.37 minutes vs 17.75± 3.21 minutes (P>0.05), respectively. Although the total procedure time was significantly shorter in the transfemoral group (27.89± 3.95 minutes) than in the transradial group (29.75± 4.38 minutes) (P<0.05), the overall PCI success rate was similar between the two groups (96.2 % vs 96.7 %). Use of the transradial approach was associated with fewer access site complications (2.2 % vs 11.4 %, P<0.05) and a shorter length of hospital stay (10.6 days vs 13.8 days, P<0.05). At six-month follow-up, the cumulative cardiac event-free survival rate was 86.1% and 86.4%(P>0.05), respectively, in the transradial and transfemoral groups. Conclusions Transradial approach achieved similar effectiveness as transfemoral approach in emergency PCI. However, the use of the transradial approach decreased access complications and hospital stay. Primary PCI via transradial approach is safe, effective, and feasible in patients with AMI. Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods One hundred and ninety five patients with AMI undergone primary PCI were randomized into two groups using different catheters insertion pathways: 105 cases by transfemoral approach and 90 cases by transradial approach. We compared data of different operating approaches in terms of success rate of access, cannulation time, the time from local anesthesia to the first balloon inflation, the total procedure time, success rate of PCI, access site complications, total duration of hospitalization, and the clinical outcomes at six-month follow-up. Results The success rate of artery puncture, cannulation time, and the time from local anesthesia to the first balloon inflation in the transradial and transfemoral groups were 98.9% vs 100% (P> 0.05), 3.15 ± 1.56 minutes vs 2.86 ± 0.97 minutes (P> 0 .05), and 18.56 ± 4.37 minutes vs 17.75 ± 3.21 minutes (P> 0.05), respectively. Although the total procedure time was significantly shorter in the transfemoral group (27.89 ± 3.95 minutes) than in the transradial group (29.75 ± 4.38 minutes (P <0.05), the overall PCI success rate was similar between the two groups (96.2% vs 96.7%). Use of the transradial approach was associated with fewer access site complications (2.2% vs 11.4%, P <0.05) and At six-month follow-up, the cumulative cardiac event-free survival rate was 86.1% and 86.4% (respectively, P <0.05), respectively, in the However, the use of the transradial approach decreased access complications and hospital stay. Primary PCI via transradial approach is safe, effective, and feasible in patients with AMI.