OBJECTIVES: This study compares the transradial versus the transfemoral approach for time to intervention for patients presenting with ST elevation myocardial infarction (STEMI). BACKGROUND: Survival following STEMI is associated with reperfusion times (door-to-balloon; D2B). For patients undergoing primary PCI for acute STEMI, potential effects of transradial approach (r-PCI) as compared with the femoral artery approach (f-PCI) on D2B times have not been extensively studied. METHODS: Consecutive patients presenting with STEMI at a tertiary care medical center were enrolled in a comprehensive-Heart Alert program (HA) and included in this analysis. Time parameters measured included: door-to-ECG, ECG-to-HA activation, HA activation-to-cath lab team arrival, patient arrival in cath lab to arterial access, and arterial access-to-balloon inflation. RESULTS: Of 240 total patients, 205 underwent successful PCI (n = 124 r-PCI; n = 116 f-PCI). No significant difference was observed in the pre-cath lab times. Mean case start times for r-PCI took significantly longer (12.5 +/- 5.4 min vs. 10.5 +/- 5.7 min, P = 0.005) due to patient preparation. Once arterial access was obtained, balloon inflation occurred faster in the r-PCI group (18.3 vs. 24.1 min; P < 0.001). Total time from patient arrival to the cardiac cath lab to PCI was reduced in the r-PCI as compared to the f-PCI group (28.4 vs. 32.7 min, P = 0.01). There was a small but statistical difference in D2B time (r-PCI 76.4 min vs. f-PCI 86.5 min P = 0.008). CONCLUSIONS: Patients presenting with STEMI can undergo successful PCI via radial artery approach without compromise in D2B times as compared to femoral artery approach.