Background: The selection of vascular access is an important determinant of procedural success, safety, vascular complications, patient satisfaction, and hospital length of stay during percutaneous coronary intervention (PCI). Although current international guidelines recommend transradial access (TRA) as the preferred approach, comparative data between transradial and transfemoral access (TFA) in the Mongolian population remain limited. Therefore, this study aimed to compare the clinical and patient reported outcomes of the two vascular access strategies in Mongolia. Aim: To compare the clinical outcomes of transradial and transfemoral access in patients undergoing coronary angiography and percutaneous coronary intervention. Materials and Methods: A hospital-based cohort study was conducted including 200 consecutive patients undergoing coronary angiography or PCI. Participants were equally allocated into the transradial access group (TRA, n=100) and the transfemoral access group (TFA, n=100). Demographic characteristics, post procedural pain assessed using the Visual Analogue Scale (VAS), length of hospital stay, access site complications, early mobility, and patient reported satisfaction were evaluated. Patient satisfaction was assessed using a five point Likert scale based on internationally recognized patient reported outcome domains. Statistical analyses were performed using SPSS version 25.0. Continuous variables were compared using the independent samples t-test or Mann-Whitney U test, whereas categorical variables were analyzed using the Chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Result: The mean age of the participants was 60.8±11.56 years, and 75.5% were male. Patients treated via transradial access experienced significantly lower post procedural pain than those treated through transfemoral access (VAS: 2.5±0.29 vs. 3.4±0.21; p=0.031). Early mobility within 24 hours after the procedure was significantly better in the TRA group (p=0.009). Minor vascular complications and hematoma (<10 cm) occurred only in the transfemoral group (1.0% each), while no major vascular complications were observed in either group. Patient-reported assessment of treatment outcomes and symptom improvement (p=0.048) and overall patient satisfaction (p=0.041) were significantly higher in the transradial group. No significant differences were observed between the groups regarding perceived healthcare service quality, accessibility, or physician–patient communication (p>0.05). Conclusion Compared with transfemoral access, transradial access was associated with lower post-procedural pain, better early recovery, fewer access-site complications, and higher patient-reported treatment outcomes and overall satisfaction, supporting its use as the preferred vascular access strategy for coronary angiography and PCI.