The association between operator volume and mortality in primary percutaneous coronary intervention (PPCI) operations for ST-elevation myocardial infarction was examined. Patients who received PPCI between 2010 and 2017 in all nonfederal New York State hospitals authorized to conduct PCI were included in this study. For a study, researchers sought to examine risk-adjusted in-hospital/30-day mortality for radial access (RA) and femoral access (FA), as well as the relationship between risk-adjusted in-hospital/30-day mortality and operation volume for each access site. During the study period, the prevalence of RA increased from 8% in 2,010 to 43% in 2017 among 44,540 patients (P<0.0001). During the period, there was no significant change in PPCI risk-adjusted mortality (P=0.27 for trend). Using operator exclusion criteria from recent clinical studies, RA was associated with reduced mortality. There was a strong negative connection between operator volume and mortality for FA procedures but not RA procedures. FA procedures performed by FA operators with the lowest volume (lowest quartile) were associated with higher risk-adjusted mortality compared to RA procedures (3.71% vs. 3.06%, P=0.01) or FA procedures performed by FA operators with the highest volume (3.71% vs. 3.16%, P=0.01). In conclusion, there was a considerable increase in the use of RA in patients with ST-elevation myocardial infarction referred for primary PCI in New York State. However, in-hospital/30-day mortality remained relatively consistent. In conclusion, this data emphasized the requirement for operators to maintain FA abilities and monitor FA results with vigilance.