Objective: To compare effectiveness and safety between distal and traditional radial artery approaches in coronary angiography (CAG) and percutaneous coronary intervention (PCI). Methods: A total of 80 patients with coronary heart disease who received CAG and PCI at Xinyu Yinhe Hospital from April 2024 to March 2025 were selected. Using random number table method, they were assigned to the observation group (40 cases treated with distal radial artery approach) and the control group (40 cases treated with traditional radial artery approach). Comparisons were made between the two groups on puncture time, postoperative pressing time for hemostasis, incidence of radial artery occlusion, success rate of puncture, the diameter of the punctured artery before operation and at 48 h postoperatively, preoperative and 3-h postoperative NR scores. Statistics of complications in both groups. Results: The puncture time and postoperative pressing time for hemostasis were shorter in the observation group than in the control group (P<0.05). The incidence of radial artery occlusion and success rate of puncture were comparable between the two groups (P>0.05). Preoperative diameter of the punctured artery and NR score were comparable between the two groups (P>0.05). NR score of the observation group was lower than that of the control group at 3 h postoperatively (P<0.05). The diameter of the punctured artery at 48 h postoperatively was comparable between the two groups (P>0.05). The difference in complication rates between the two groups was not statistically significant (P>0.05). Conclusion: Compared with traditional radial artery approach, distal radial artery approach can shorten the puncture time and postoperative hemostasis time of CAG and PCI, and alleviate pain at 3 h postoperatively.