Valentijn 2012.

Study characteristics
General information	Objective  Added biomarkers Journal American Journal of Cardiology Country The Netherlands Study design Prospective cohort study
Participants	Number of included patients 1172 Surgical specialty Vascular surgery Age Mean 68 years (SD 10 years) Male sex 74% High‐risk surgery Not reported   Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease 40.4% History of congestive heart failure 9.4% History of cerebrovascular events 33.5% Elevated creatinine 5.3% 0 to 1 RCRI factors 57.3% 1 RCRI factor Not reported 2 RCRI factors 27% 3 or more RCRI factors Not reported
Predictors	Predictor 1: Aortic value function (aortic valve sclerosis) Objective: added biomarker  Category: imaging Scale: dichotomous Threshold: defined by the presence of thickening and/or calcium of 1 cusp of a tricuspid valve not inducing stenosis (i.e. with a maximal velocity < 2.5 m/s) Assay/device: portable Acuson Cypress ultrasound system (Acuson, A Siemens, Mountain View, California) with a 7V3c transducer or a portable Vivid‐I ultrasound System (Vivid‐I, GE Healthcare, Solingen, Germany) with a 3S‐RS transducer   Predictor 2: Aortic value function (aortic valve stenosis) Objective: added biomarker  Category: imaging Scale: dichotomous Threshold: defined as a jet velocity > 2.5 m/s Assay/device: portable Acuson Cypress ultrasound system (Acuson, A Siemens, Mountain View, California) with a 7V3c transducer or a portable Vivid‐I ultrasound System (Vivid‐I, GE Healthcare, Solingen, Germany) with a 3S‐RS transducer
Outcome	Outcome category All‐cause mortality Full outcome definition Not applicable Prediction horizon 4 years after surgery
Analysis	Domain 1: Participant selection Low Justification:  Domain 2: Predictors High Justification: some of the echocardiographies were performed in the 30 days after surgery Domain 3: Outcome High Justification: outcome is all‐cause mortality and not MACE
PROBAST: Applicability	Domain 1: Participant selection Low Justification: patient selection was appropriate and generalisable to the population used in the RCRI development study Domain 2: Predictors High Justification: some of the echocardiographies were performed in the 30 days after surgery Domain 3: Outcome High Justification: outcome is all‐cause mortality and not MACE Overall judgement High Justification: patients selected were generalisable to the patient population used in the RCRI development study. However, some predictors were measures after surgery and outcome definition was different compared to the development study.
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	No	Some of the echocardiographies were performed in the 30 days after surgery.
Domain 3: Outcome	Yes	Clearly defined outcome definitions and appropriate adjudication of outcomes.
Domain 4:  Analysis	No	Categorisation of predictors; no performance measures for additive predictive performance are reported; complete case analysis.
Overall judgement	No	Patient selection was appropriate. Outcomes were clearly defined and assessed. However, some predictors were not preoperatively available. Furthermore, predictors were categorised, complete case analysis was performed and no reclassification measures were reported.