Background: Percutaneous coronary intervention (PCI) is extensively implemented as a minimally invasive method of revascularizing coronary arteries to treat coronary artery disease. Historically, the transfemoral approach (TFA) was the primary access site, but the transradial approach (TRA) has been introduced due to benefits such as less bleeding, earlier patient mobilization, and improved patient comfort.

Aim: To compare the clinical outcomes, procedural variables, and complication rates associated with percutaneous coronary intervention using transradial or transfemoral intervention methods in a tertiary care facility.

Methods: A comparative observational study was conducted at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) between September 2023 and February 2024. Ninety patients undergoing PCI were split into two groups: Group A ($n=45$, transradial approach) and Group B ($n=45$, transfemoral approach). Demographic variables, procedure length, contrast volume, vascular complications, bleeding, and hospital stay were collected and analyzed using SPSS.

Results: Procedural parameters showed that mean procedure time and fluoroscopy time were shorter in the transradial group compared to the transfemoral group ($p = 0.003$ and $p = 0.001$, respectively). Vascular access site complications were significantly lower in the transradial group (4.4%) compared to the transfemoral group (17.8%, $p = 0.03$). Major bleeding occurred in 2.2% of transradial vs 13.3% of transfemoral cases ($p = 0.04$). Mean hospital stay was significantly shorter for the transradial group ($1.9 \pm 0.6$ days) than the transfemoral group ($3.2 \pm 0.8$ days, $p < 0.001$). Technical success rates were similar between both approaches.

Conclusion: The transradial approach for PCI results in significantly fewer vascular complications, lower bleeding risks, faster ambulation, and reduced hospitalization compared to the transfemoral route, without compromising procedural success. It serves as a safer and more patient-friendly access route in tertiary care settings.

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