## 4 Discussion
Because of this obstruction, the heart receives less blood, which damages the heart muscle and raises blood levels of cardiac biomarkers like cTnI and cTnT. When opposed to Type 2 myocardial infarction, NSTEMI frequently has a more severe blockage and extensive heart muscle injury, which raises troponin levels and, in turn, the ratios in relation to the cut-off values. On the other hand, disorders such as severe hypertension, tachycardia, or anemia that lead to an imbalance between the supply and demand of oxygen to the heart are typically the cause of Type 2 myocardial infarction. Although cardiac muscle damage and elevated troponin levels can also result from these disorders, the degree of damage is frequently less severe than in NSTEMI. Despite having distinct structures and functions, cardiac troponin I and T are both sensitive and precise indicators of myocardial damage. Compared to cTnT, cTnI typically rises earlier and peaks sooner following the onset of symptoms. Variations in their intracellular location and binding characteristics within the myofilaments may be the cause of these variances in release kinetics. The underlying pathophysiological mechanisms, which include the degree of myocardial damage, the onset and duration of ischemia, and subsequent reperfusion injury, are responsible for the changes in cTnI and cTnT levels among different types of myocardial infarction [15; 27]. It is essential to understand these pathways in order to properly manage patients with acute coronary syndromes and interpret troponin levels in clinical practice. The ratios of cTnI and cTnT relative to their cut-off values in the NSTEMI group were higher in female than in male patients (53.3 vs. 24.6 ng/L); the same difference was found for the ratios of cTnT (20.8 vs. 13.1 ng/L), suggesting that women with NSTEMI have higher relative elevations of troponin levels. In the same manner, the ratios in the Type 2 group were higher in female than in male patients for cTnI (25.6 vs. 12.7 ng/L) as well as for cTnT (19.0 vs. 6.73 ng/L). These differences could be due to biological differences such as variations in heart size, and hormone levels, but they could also be influenced by other factors contributing to different damage responses. High troponin levels at admission (more than five times above the 99 th percentile) and positive ECG alterations can aid in referring patients to prompt invasive therapy when utilizing a high-sensitivity assay. When paired with a normal ECG, normal troponin values (below the 99 th percentile) will facilitate the early rule-out of MI and the patient's discharge [28]. Negative troponin findings will support the exclusion of MI, particularly in the case of late arrivals (chest discomfort more than six hours prior to admission). Retesting within three to six hours is necessary if moderately positive troponin values or negative troponin results cause early arrivals [29]. The high sensitivity of troponin testing is undoubtedly one of its benefits. There is little chance of overlooking patients experiencing an acute MI when sensitivity is strong. In addition, high sensitivity promotes safe and early rule-out algorithms, even in cases where fewer patients may benefit than with the rule-out performance provided by modern troponin assays. The high sensitivity troponin assays' enhanced sensitivity has the drawback of decreasing specificity and raising the possibility of false-positive results that indicate ACS. Even if there is less chance of missing MI when utilizing a high-sensitivity troponin assay, patients with other morbidities such as renal illness or elderly patients without ACS may still have somewhat elevated or altered troponin levels. Due to the higher number of false positives connected to high-sensitivity troponin testing, there will be a greater requirement for diagnostic follow-up and a potential danger of receiving the wrong kind of treatment. Non-coronary causes of possible troponin elevation in our study were: cellulitis, pneumonia, COPD exacerbation, cholangitis, and diabetes.