Gualandro 2018.

Study characteristics
General information	Objective  Added biomarkers, biomarkers compared Journal American Heart Journal Country Switzerland and Brazil Study design Prospective cohort study
Participants	Number of included patients 243 Surgical specialty Vascular surgery Age Median 68 years (IQR = 62 to 74) Male sex 73% High‐risk surgery Not reported Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease 39% History of congestive heart failure 16% History of cerebrovascular events 25% Elevated creatinine Not reported 0 RCRI factors 10% 1 RCRI factor 35% 2 RCRI factors 35% 3 or more RCRI factors 20%
Predictors	Predictor 1: High‐sensitivity troponin T Objective: added biomarker, biomarker compared Category: blood Scale: continuous, dichotomous Threshold: > 14 ng/L Assay/device: Elecsys, Roche diagnostics, Mannheim, Germany   Predictor 2: High‐sensitivity troponin I Objective: added biomarker, biomarker compared Category: blood Scale: continuous, dichotomous Threshold: > 13 ng/L Assay/device: ARCHITECT high‐sensitivity STAT Troponin I assay, Abbott Laboratories   Predictor 3: Sensitive cardiac troponin I Objective: biomarker compared Category: blood Scale: continuous, dichotomous Threshold: > 13 ng/L Assay/device: s‐cTnI, Siemens Ultra, Advia Centaur immunoassay system
Outcome	Outcome category MACE Full outcome definition Cardiac arrest, perioperative myocardial infarction, clinically relevant arrhythmia and acute heart failure (AHF) Prediction horizon 30‐day events
Analysis	Number of outcomes 58         Handling missing data Complete case analysis Discrimination reported? Yes Calibration reported? No   Reclassification reported? No
PROBAST: Applicability	Domain 1: Participant selection Low Justification: patient selected were generalisable to the patient population used in the RCRI development study Domain 2: Predictors Unclear Justification: unclear what definitions for the RCRI has been used Domain 3: Outcome Low Justification: outcome definitions were clearly defined and comparable to the definitions used in the development study Overall judgement Unclear Patient selected were generalisable to the patient population used in the RCRI development study. Outcomes definitions were clearly defined and comparable to definitions used in the RCRI development study. However, there was no information on the definition of predictors and their assessment.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	Yes	Although only patients undergoing vascular surgery were included, participant selection was appropriate and the RCRI model can be applied in these patients.
Domain 2: Predictors	Unclear	Unclear what definitions for the RCRI has been used.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Low number of outcomes; exclusion of patients (> 50%) without preoperative troponin; no measures of calibration or reclassification reported.
Overall judgement	No	Patient selection was appropriate. Outcomes were clearly defined and assessed. However, predictors definitions were not clear/reported. Furthermore, the number of outcomes was low, inappropriate exclusion of patients with missing data and no calibration/reclassification measures were reported.