Background: The radial approach is replacing the femoral route as the preferred first-line method for coronary angiography (CA) and percutaneous coronary intervention (PCI). Aim: to evaluate whether ulnar approach is non-inferior to radial approach as regards feasibility, safety and hand function preservation. Patients and methods: This cohort study involved 140 patients with CAD who underwent coronary procedures and were divided equally into patients for radial approach (group I) and patients for ulnar approach (group II). Hand function and radial patency were followed up till 6 months. Results: There was no statistically significant differences or association between both groups, in ulnar group 41 patients (58.6%) had acute coronary syndrome (ACS) and 29 patient had CCS (41.4%), while in radial group 39 patients had ACS (55.7%) and 31 patients had CCS (44.3%), (p=0.73). There was statistically significant difference in hand function in both groups as hand function significantly decreased at 1 day after the procedure in peak and mean then increased nearly to base level at six months in peak and mean. Conclusion: ulnar approach is non-inferior to radial approach as regards feasibility, safety and hand function preservation.