This document discusses rates of transradial access failure in percutaneous coronary intervention (PCI) cases. In a high-volume radial center, transradial access failed in 2.7% of all PCI cases and 1.8% required crossover to transfemoral access during the procedure. Among STEMI patients, 5% had primary transradial failure and 2.2% had crossover failure. Risk scores were developed to predict failure - for all comers it was based on female gender, prior CABG, and cardiogenic shock; for STEMI it considered 9 factors including age, weight, creatinine, the operator's radial experience, and intubation status. These scores had good predictive ability to identify patients at higher