Background: Trans-radial approach (TRA) gained sound acceptance as an alternative to trans-femoral approach (TFA), however, still having numerous pitfalls as hematoma, spasm and radial artery occlusion. Objectives: To evaluate the feasibility and safety of TRA for coronary angiography (CAG) and percutaneous coronary intervention (PCI) compared with the TFA in ST segment elevation myocardial infarction (STEMI) patients. Methods: Our study was a prospective analysis enrolled 100 consecutive patients presented with acute STEMI. The patients were randomly assigned to get vascular access either from TFA (Group I, 50 patients) or from TRA (Group II, 50 patients). The clinical, technical, procedural and post-procedural data collected. Results: Group I was younger than Group II (53.0±8.4) versus (55.8±10.9 years), however didn't reach a statistical significance (p= 0.156). History of prior STEMI was significantly more in group II (6% versus 16%, p=0.032). There was no difference between the two groups regarding the procedural success (98% versus 96%) and number of attempts to fix the femoral or radial sheath. However, the total procedure time, amount of contrast usage and fluoroscopic time were significantly higher in radial group (42.2 ± 16.8 versus 77.4 ± 27.1 minutes), (157.4 ± 10.8 versus 181.2 ± 16.7 milliliter) and 8.74 ± 3.8 versus 18.64 ± 7.1 minute) with p=0.001 respectively. The frequency of acute complications was similar in both groups despite hematoma was less in group II, however, it didn't reach statistical significance. Conclusions: Our study demonstrated the radial access is a safe and practical approach for coronary angiography or angioplasty in ST segment elevation myocardial infarction patients compared to femoral access, without major complications, however, the procedure time was significantly longer with higher usage of contrast media and fluoroscopic time.