Backgrounds: It is not still unclear which procedure is superior between TRI and TFI in terms of in-hospital morbidities and outcomes in acute myocardial infarction patients. Methods: Using KORMI (Korean registry of myocardial infarction) data (from 2008 January to 2011 Aug), in-hospital morbidities and cumulative clinical outcomes of TRI group were compared to those of TFI group in STEMI and NSTEMI patients. Data of 9,412 patients (documented about route of access and procedure strategy) were evaluated (STEMI, n=6,798 and NSTEMI, n=2,614). Results: Based on baseline characteristics, the patients in TFI group (n=7,607) were older, more over-weighted, female patients, resuscitations before arrival, STEMI patients, worse Killip class and MR grade. TRI group (n=1,805) had lower in-hospital morbidities, especially major bleedings and puncture site complications, ICU admission, inotropics apply, all cause mortality and MACE at discharge and 1 month later. The post-TIMI flow and success rate of PCI were not significantly different between two groups, however. In multivariate analysis, type of myocardial infarction, inotropic apply, ICU admission and all cause mortality were related to the route of access. In-hospital morbidities and MACE at 1 month were not related to the route of access. Conclusions: Patients of TRI group had showed less STEMI patients and lower all cause mortality. The in-hospital morbidities and 1 month MACE of TRI were not different from those of TFI, however. It requires prospective and randomized controlled trials to assess clinical efficacy and in-hospital morbidities related to route of access for interventional procedure adequately.