Sheth 2015.

Study characteristics
General information	Objective  Added biomarkers, biomarkers compared Journal BMJ Country Canada, USA, China, South Africa, Malaysia, India, Poland Study design Prospective cohort study
Participants	Number of included patients 955 Surgical specialty Noncardiac surgery Age Mean 69.7 years (SD 8.5 years) Male sex 61% High‐risk surgery Not reported   Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease 32% History of congestive heart failure 4% History of cerebrovascular events Not reported Elevated creatinine Not reported 0 RCRI factors 34% 1 RCRI factor 43% 2 RCRI factors 19% 3 or more RCRI factors 6%
Predictors	Predictor 1: Coronary CT angiography Objective: added biomarker, biomarker compared Category: imaging Scale: categorical; dichotomous Threshold: normal ‐ no evidence of coronary atherosclerosis; non‐obstructive coronary artery disease ‐ evidence of at least one coronary artery plaque with a < 50% stenosis; obstructive coronary artery disease ‐ at least one coronary artery plaque with a ≥ 50% stenosis; or extensive obstructive disease —≥ 50% stenosis in two coronary arteries including the proximal left anterior descending artery, ≥ 50% stenosis in three coronary arteries, or ≥ 50% stenosis in the left main coronary Assay/device: the protocol used for coronary CT angiography is reported in Appendix 1 of the original research paper.
Outcome	Outcome category MACE Full outcome definition Cardiac death or nonfatal myocardial infarction Prediction horizon 30‐day events
Analysis	Number of outcomes 74 Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? No Reclassification reported? Yes
PROBAST: Applicability	Domain 1: Participant selection High Justification: many exclusion criteria including persistent atrium fibrillation, patients with previous stent implantation. However, they could not have done it differently as these exclusions were due to CTA measurements. Domain 2: Predictors Unclear Justification: no information for each of the RCRI predictor definitions Domain 3: Outcome High Justification: outcome MACE differs from the definition of MACE in the development study Overall judgement High Justification: only a selected group of patients was included, there was no/unclear information on predictor definitions and outcome definition was different compared to 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	Unclear	No information for each of the RCRI predictor definitions.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Low number of outcomes; no information on handling missing outcome; no reporting on calibration measures.
Overall judgement	No	Patient selection was appropriate. Outcome was clearly defined and assessed. However, predictor definitions were unclear/not reported. Furthermore, the number of outcomes was low, no information on the handling of missing data and inappropriate reporting of performance measures.