van Klei 2007.

Study characteristics
General information	Objective  Added biomarkers Journal Annals of Surgery Country Canada and the Netherlands Study design Prospective cohort study
Participants	Number of included patients 2967 Surgical specialty Noncardiac surgery Age Mean 64.9 years (SD 9.2 years) Male sex 56% High‐risk surgery 53.8% Insulin‐dependent diabetes mellitus 5.5% History of ischaemic heart disease 10.5% History of congestive heart failure 1.8% History of cerebrovascular events 4.1% Elevated creatinine 2.7% 0 RCRI factors 31.6% 1 RCRI factor 42.6% 2 RCRI factors 19.8% 3 or more RCRI factors 6%
Predictors	Predictor 1: Left bundle branch block on ECG Objective: added biomarker  Category: imaging Scale: dichotomous Threshold: not applicable Assay/device: not reported   Predictor 2: Right bundle branch block on ECG Objective: added biomarker  Category: imaging Scale: dichotomous Threshold: not applicable Assay/device: not reported   Predictor 3: Male gender Objective: added biomarker  Category: patient characteristic Scale: dichotomous Threshold: not applicable Assay/device: not reported
Outcome	Outcome category Myocardial infarction Full outcome definition Not applicable Prediction horizon In‐hospital events
Analysis	Number of outcomes 72 Handling missing data Complete case analysis Discrimination reported? Yes Calibration reported? No Reclassification reported? No
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 Low Justification: predictor definitions were clearly defined and comparable to the definitions used in the development study Domain 3: Outcome High Justification: outcome is myocardial infarction and not MACE 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	Troponin, ECG and echocardiography were not measured in all patients, only on clinical indication.
Domain 4:  Analysis	No	Low number of outcomes, complete case analysis and no reporting on calibration and reclassification measures.
Overall judgement	No	Patient selection was appropriate. Predictors were clearly defined and assessed. However, troponin, ECG and echocardiography were only measured on clinical indication. In addition, the number of outcomes was low, complete case analysis and no calibration was reported.