Backgrounds: Transradial intervention (TRI) is drastically increasing because of the lower incidence of major bleeding and vascular complications compared with transfemoral intervention (TFI). However, there have been very limited data regarding clinical outcomes of TRI versus TFI in acute myocardial infarction (AMI) patients (pts). Methods: A total 1748 consecutive AMI pts of nine major hospitals were enrolled from January to December 2009. In-hospital complications and cumulative clinical outcomes up to six months were compared between TRI group (n=1003, 57.4%) and TFI group (n=745, 42.6%). Results: Baseline characteristics showed that pts in TRI group were younger, more smoker, dyslipidemia, prior percutaneous coronary intervention (PCI), whereas TFI group had more STEMI, ant wall MI and multivessel disease. In-hospital complication showed that TRI group had lower incidence of cardiogenic shock, major and minor hemorrhage and transfusion. Clinical outcomes up to six months showed that cardiac death, TLR, TVR, TLR- & TVR-(MACEs were lower in the TRI group (Table). Multivariate analysis showed that TRI was an independent predictor of reducing total death (Adjusted OR: 0.283, 95% CI: 0.081-0.992, p-value=0.049) and TVR-MACE (Adjusted OR: 0.304, 95% CI: 0.098-0.942, p-value<0.039) at 6 months. Conclusions: In our study, TRI in AMI pts undergoing PCI was associated with lower in-hospital and 6 months cardiac death, TLR, TVR, TLR- and TVR-MACE. We suggest that TRI may play an important role in improving mid-term major clinical outcomes of AMI pts undergoing PCI in the DES era