Transradial coronary intervention (TRI) is commonly performed in Japan, but its efficacy may differ from that in Western countries, particularly given the smaller body habitus of Japanese patients. We compared the clinical outcomes of TRI with those of transfemoral coronary intervention (TFI) and evaluated their relationship with body mass index in a multicenter registry. We analyzed data from 1230 patients who underwent percutaneous coronary intervention (TRI 306, TFI 924) at 14 Japanese hospitals from September 2008 to August 2010. Multivariate logistic regression analysis was performed to evaluate the odds ratio regarding complications between TRI and TFI. Propensity scores were used to adjust for differences in TRI and TFI, extracting 274 matched patients from each group for comparisons. The overall complication rate was significantly lower (10.8 vs. 18.0%, p = 0.003) and the bleeding complication rate trended lower (4.6 vs. 7.6%, p = 0.088) in TRI than in TFI. TRI was moderately associated with a smaller bleeding risk after multivariable adjustment (OR 0.54; p = 0.072). After propensity score matching, TRI was associated with significantly lower complication rates compared with TFI (9.5 vs. 18.2%, p = 0.003), especially bleeding complications (3.3 vs. 9.9%, p = 0.002) and puncture site bleeding (1.1 vs. 5.5%, p = 0.004). Notably, bleeding rate was inversely related to body mass index in both groups. TRI appeared to be a safe alternative to TFI in this Japanese real-world multicenter registry, which includes high numbers of TRI.