Rohde 2001.

Study characteristics
General information	Objective  Added biomarkers, biomarkers compared Journal American Journal of Cardiology Country USA Study design Prospective cohort study
Participants	Number of included patients 570 Surgical specialty Noncardiac surgery Age Mean 66 years (SD 10 years) Male sex 40% High‐risk surgery Not reported   Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease Not reported History of congestive heart failure 5% History of cerebrovascular events 13% Elevated creatinine Not reported 0 RCRI factors 0% 1 ‐2 RCRI factors 39.8% 3 or more RCRI factors 60.2%
Predictors	Predictor 1: Abnormal echocardiography Objective: added biomarker, biomarker compared  Category: imaging Scale: dichotomous Threshold: the presence of any degree of systolic dysfunction, or moderate to severe LV hypertrophy, or moderate to severe mitral regurgitation, or aortic gradient > 20 mm Hg Assay/device: not reported   Predictor 2: Any degree of systolic dysfunction on echocardiography Objective: biomarker compared  Category: imaging Scale: categorical Threshold: normal function (1), mild (2), moderate (3) or severe systolic dysfunction (4) Assay/device: not reported   Predictor 3: Any degree of systolic dysfunction or moderate to severe left ventricular hypertrophy on echocardiography Objective: biomarker compared  Category: imaging Scale: categorical Threshold: normal function (1), mild (2), moderate (3) or severe systolic dysfunction (4); normal thickness and mild hypertrophy (1) or moderate to severe hypertrophy (2) Assay/device: not reported
Outcome	Outcome category MACE Full outcome definition Myocardial infarction, cardiogenic pulmonary oedema, ventricular fibrillation or primary cardiac arrest, and sustained complete heart block Prediction horizon In‐hospital events
Analysis	Number of outcomes 44 Handling missing data Complete case analysis Discrimination reported? Yes Calibration reported? No  Reclassification reported? No
PROBAST: Applicability	Domain 1: Participant selection High Justification: only patients who underwent preoperative TTE were included in the analysis Domain 2: Predictors Low Justification: predictor definitions were clearly defined and comparable to the definitions used in the development study Domain 3: Outcome Low Justification: outcome definitions were clearly defined and comparable to the definitions used in the development study Overall judgement High Justification: only a selected group of patients was included, that was not generalisable to the patient population used in the RCRI development study. However, predictors and outcomes were clearly defined/assessed and comparable as used in the RCRI development study.
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	No	Only patients who underwent preoperative TTE were included in 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	Low number of outcomes, no information on the handling of missing data and no reporting on calibration/reclassification measures.
Overall judgement	No	Predictors and outcomes was clearly defined and assessed. However, patient selection was inappropriate, the number of outcomes was low, no information on handling of missing data and inappropriate reporting of performance measures.