Ahn 2013.

Study characteristics
General information	Objective  Added value biomarkers Biomarkers compared Journal Journal of American College of Cardiology Country Republic of Korea Study design Retrospective cohort study
Participants	Number of included patients 239 Surgical specialty Noncardiac surgery Age Median 69 years (IQR 62 to 75) Male sex 52.3% High‐risk surgery Not reported Insulin‐dependent diabetes mellitus 13% History of ischaemic heart disease Not reported History of congestive heart failure 3.3% History of cerebrovascular accidents 10.9% Elevated creatinine Not reported 0 RCRI factors 43.9% 1 RCRI factor 41% 2 RCRI factors 11.7% 3 or more RCRI factors 3.3%
Predictors	Predictor 1: Coronary artery calcium scores (CACS) Objective: added value, biomarker compared Category: imaging Scale: dichotomous Threshold: 113 CACS Assay/device: Brilliance 64, Philips Healthcare, Best, the Netherlands Predictor 2: Multi‐vessel disease  Objective: added value Category: imaging Scale: categorical Threshold: significant stenosis (50% luminal diameter narrowing) in 1, 2 or 3 vessels Assay/device: Brilliance 64, Philips Healthcare, Best, the Netherlands Predictor 3: Coronary artery calcium scores (CACS) + multi‐vessel disease  Objective: added value Category: imaging Scale: categorical Threshold: not applicable Assay/device: Brilliance 64, Philips Healthcare, Best, the Netherlands
Outcome	Outcome category MACE Full outcome definition Cardiac death, acute coronary syndrome (nonfatal myocardial infarction and unstable angina), pulmonary oedema, ventricular fibrillation, ventricular tachycardia with haemodynamic compromise, and complete heart block Prediction horizon 30‐day events
Analysis	Number of outcomes 19  Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? Yes Reclassification reported? Yes
PROBAST: Applicability	Domain 1: Participant selection Low Domain 2: Predictors Low Domain 3: Outcome Low Overall judgement: Low Patient selection was appropriate; predictor and outcome definitions were clearly defined and comparable to the definitions used in the development study.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	No	Patients with severe cardiac morbidities such as previous myocardial infarction, severe heart failure or severe valvular disease were excluded from the analysis.
Domain 2: Predictors	Yes	Clear (RCRI) predictor definitions were described.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Small number of outcomes. No information on how missing data were handled.
Overall judgement	No	Patients with severe cardiac morbidities were excluded from the analysis. In addition, there was a small number of outcomes and no information on handling of missing data. However, predictor and outcome definitions were clearly reported and assessed.