Boersma 2001.

Study characteristics
General information	Objective  Added biomarkers Journal JAMA Country Netherlands and Italy Study design Prospective cohort study
Participants	Number of included patients 1351 Surgical specialty Vascular surgery Age Not reported Male sex 78% High‐risk surgery Not reported Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease Not reported History of congestive heart failure 5.3% History of cerebrovascular events 8.8% Elevated creatinine 4.1% 0 RCRI factors 45% 1 RCRI factor 38% 2 or more RCRI factors 17%
Predictors	Predictor 1: Dobutamine stress echocardiography (DES) + betablocker use Objective: added biomarker Category: imaging  Scale: dichotomous Threshold: worsening of ≥ 1 point during the stress test using a 5‐point ordinal scale Assay/device: not reported
Outcome	Outcome category MACE  Full outcome definition Cardiac death or nonfatal myocardial infarction Prediction horizon 30‐day events
Analysis	Number of outcomes 45 Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? Yes  Reclassification reported? No
PROBAST: Applicability	Domain 1: Participant selection High Justification: population very different from the development study; only high‐risk patients included Domain 2: Predictors Low Justification:  Domain 3: Outcome High Justification: outcome is cardiovascular death with myocardial infarction in this study and MACE in the development study Overall judgement High Justification: only high‐risk patients were included. Predictors were clearly defined. However, the outcome used was different compared to the development study.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	No	Only patients with at least one cardiac risk factor had a DSE meaning that only high‐risk patients were assessed.
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	Low number of outcomes and no information on handling missing data.
Overall judgement	No	Only high‐risk patients were included. Predictors and outcomes were clearly defined. However, the number of outcomes was low and there was no information on handling missing data.