Douville 2020.

Study characteristics
General information	Objective  Added biomarkers, prediction model compared Journal Circulation: Genomic and Precision Medicine Country USA Study design Prospective cohort study
Participants	Number of included patients 89,624 Surgical specialty Noncardiac surgery Age Median 55 years (IQR = 42 to 65) Male sex 45% High‐risk surgery Not reported Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease Not reported History of congestive heart failure Not reported History of cerebrovascular events Not reported Elevated creatinine Not reported 0 RCRI factors Not reported 1 RCRI factor Not reported 2 RCRI factors Not reported 3 or more RCRI factors Not reported
Predictors	Predictor 1: Polygenic risk score (CAD)    Objective: added biomarker Category: blood Scale: continuous Threshold: not applicable Assay/device: Illumina Infinium CoreExome‐24   Predictor 2: Preoperative model (age, admission type, composite RCRI, arrhythmia, fluid/electrolyte disorder, hypertension) Objective: prediction model compared Category: prediction model  Scale: not applicable Threshold: not applicable Assay/device: not applicable   Predictor 3: Preoperative model + Polygenic Risk Score (CAD) Objective: prediction model compared Category: prediction model  Scale: not applicable Threshold: not applicable Assay/device: not applicable
Outcome	Outcome category Troponin elevation Full outcome definition Myocardial injury after noncardiac surgery (MINS) Prediction horizon 30‐day events
Analysis	Number of outcomes 429       Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? No Reclassification reported? Yes
PROBAST: Applicability	Domain 1: Participant selection Low Justification: However, patients might be healthier compared to the patients included in the development study Domain 2: Predictors Low Justification:  Domain 3: Outcome High Justification: troponin elevation is not similar to the outcome MACE in the development study Overall judgement High Justification: patient selection was appropriate and predictor definitions were clearly defined and comparable to definitions used in the development study. However, the outcome used was different from MACE in the development study.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	Yes	Appropriate participant selection in which patients were selected in whom the RCRI model can be applied.
Domain 2: Predictors	Yes	Clear (RCRI) predictor definitions were described.
Domain 3: Outcome	No	Troponins are not routinely drawn on all patients, but rather drawn when a clinical suspicion of MINS exists.
Domain 4:  Analysis	Yes	Clear methodology and appropriate number of outcomes.
Overall judgement	No	Appropriate patient selection, clearly defined predictors and proper methodology. However, outcomes could have been missed due to inappropriate outcome assessment.