Background: the transfemoral approach (TFA) has been until presently the main-stay for arterial access PCI in the setting of acute STEMI, while the transradial approach (TRA) is gaining ground in elective as well as primary procedures. Objectives: to assess the impact of transradial versus transfemoral approach for PCI on the outcome of patients presenting with acute coronary syndrome. Patients and Methods: prospective study was conducted on 100 patients presenting to Ain Shams University Hospitals Coronary Care Unit (CCU) with recent onset acute coronary syndrome (whether unstable angina (UA)/non–ST-segment-elevation MI (NSTEMI) or ST-segment-elevation MI (STEMI)) undergoing revascularization via percutaneous coronary intervention (PCI). Patients were randomized into 2 equal groups, for the first group PCI was performed via TFA while for the second group via TRA. Results: our study found that, with TRA we get less bleeding, less local vascular complications [8 (16%) vs 2 (4%), p=0.045] & less amount of dye used (169.60 ± 21.28 versus 187.00 ± 37.65 ml, p=0.006) without significant increase in fluoroscopy time (10.86 ±4.88 versus 9.76 ±4.74 mins, p=0.256) or radiation exposure. Although there was no significant difference in mortality and morbidity, TRA offers the patient a more simple procedure with less hospital stay (3.4 ±0.948 versus 3.86 ±0.808 days, p<0.01). Conclusion: radial artery access is a safe and effective approach for management of ACS. If performed by experienced operators, TRA should be the standard access in managing ACS specifically in STEMI.