GOLDEN BRIDGE II: AI-Supported Stroke Care Reduces Vascular Events Across 77 Hospitals
Evidence: Multicenter cluster-randomized clinical trial
Original study published: . This MedXchange brief was published on 2026-10-26.
Study Design and Methods
The BMJ cluster-randomized trial enrolled 21,603 patients with acute ischemic stroke across 77 hospitals in China. Hospitals were allocated to decision support or usual care. The primary endpoint was a new vascular event within three months. Because the intervention included several linked clinical functions, its effect estimate applies to the package delivered by the participating hospitals. The design does not assign that effect to any individual component.
Key Findings
At three months, vascular events occurred in 2.9% of the intervention group and 3.9% of controls: adjusted hazard ratio 0.74, 95% CI 0.58–0.93; P=0.01.
At 12 months, rates were 4.0% and 5.5%: adjusted hazard ratio 0.73, 95% CI 0.56–0.95; P=0.02.
Disability and all-cause mortality did not differ significantly.
Clinical Significance
A vascular-event endpoint gives the trial a different clinical meaning from a study reporting only diagnostic accuracy. The relevant observation is that outcomes differed after introduction of the complete decision-support pathway. The absolute event rates and adjusted hazard ratios convey complementary information. The rates describe the observed burden over the reported period; the hazard ratios estimate a relative time-to-event association under the study's analysis. They should not be treated as interchangeable measures.
Clinical Interpretation
The interpretation is strongest when it remains tied to what was randomized. Hospital allocation reflects the institutional setting in which care was delivered, and the adjusted analysis accounts for the study structure. A simple division of patient-level event counts does not reproduce that estimate. The clinical result supports examination of integrated decision support in stroke care. It does not establish that purchasing the imaging component alone, or deploying a different combination of software functions, would produce the same outcome.
Limitations
This was a bundled intervention evaluated in a specific health-system setting. The separate contribution of AI imaging, etiological classification and treatment recommendations cannot be resolved from the package comparison. The vascular-event findings should not be extended into a demonstrated disability or mortality benefit.
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