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IntroductionPercutaneous coronary intervention (PCI) is an integral part of treatment for ischemic heart disease. Coupled with evidence-based pharmacological strategies, the use of PCI in appropriate patients reduces morbidity and mortality across the spectrum of risk [1]. Continual evolution of antithrombotic therapy and device technology has resulted in the application of PCI to a wider population of patients [2]. Procedural success rates are high and ischemic complications relatively rare [3], thus, attention has turned to periprocedural bleeding complications [4].Bleeding events and the consequent need for transfusion are independent determinants of survival in acute coronary syndromes. Their relation to short-and long-term mortality has been demonstrated in major randomized trials as well as through the evaluation of registries.[5-8] Clinical trials evaluating new pharmacological strategies have focused on reducing this risk [9,10]; however, absolute reductions in bleeding risk have been modest across most studies. A growing body of evidence suggests that a procedural strategy-using the transradial rather than the transfemoral approach for PCI-is associated with comparatively larger reductions in bleeding complications than those achieved with any anticogulant strategy.Patients with ST−elevation myocardial infarction (STEMI) very frequently require potent adjunctive antithrombotic therapy, including glycoprotein IIb/IIIa inhibitors and hence, are especially at risk for access site related bleeding complications [11]. Recent studies has further indicated that transradial approach is safe and efficacious for elective coronary angiographic studies of outpatients [12], elective left main coronary intervention [13]. So currently, the transfemoral and transradial approach are the most popular vascular access routes for PCI worldwide. While the safety and efficacy of the transfemoral approach for acute myocardial infarction (AMI) patients undergoing primary PCI have been extensively discussed [14,15], relevant issues for using the transradial approach for primary PCI have not been fully investigated [16] in an era when transradial approach for primary PCI is already daily practice in some medical centers [17,18]. A lot of Abstract Background: Transradial approach has been used widely around the world for its unique advantages, but its use for primary percutaneous coronary intervention (pPCI) remains controversy. This study was conducted to explore the difference of major adverse cardiovascular and cerebral events (MACCE) and bleeding complications between transradial and transfemoral approach for pPCI in patients with ST−elevation myocardial infarction (STEMI).