Background: Coronary catheterization is usually performed via the trans-femoral approach. Trans-radial access offers advantages in comparison with trans-femoral access, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization, Aim and objectives: the aim of the study was to compare 30 days outcome between radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI), Subjects and methods: this was a Prospective, randomized, open-label, double-arm, single center study, that was conducted on 120 STEMI patients; subdivided randomly into 2 groups. Group A (60 patients) had Primary PCI through femoral access; Group B (60 patients) had Primary PCI through radial access, Results: Hospitalization time in group (I) was ranged between 3–8 days with mean± S.D. 5.35±1.686 days while in group (II) was ranged between 5–10 days with mean± S.D. 7.32±1.751 days. There were statistically significant differences between groups, and Complications in group (I) showed that 9(15.0%) had access site complication, 4(6.7%) had hematoma, 2(3.3%) had Pseudoaneurysm and 7(11.7%) had Radial artery spasm while in group (II) 6(10.0%) had Access site complication. There was no statistically significant difference between groups, Conclusion: trans-radial approach is an equally effective approach as trans-femoral approach similar success and complication rates.