TOKYO (AP) — The ROC has won the gold medal in women’s gymnastics after U.S. star Simone Biles exited with a medical issue.

The Russian team posted a score of 169.528, ahead of the U.S. in second place at 166.096. The American team of Sunisa Lee, Grace McCallum and Jordan Chiles competed in the final three rotations without Biles, who withdrew from the competition after vault.

The gold is the first for the Russian team since the Unified Team triumphed in Barcelona in 1992 and came a day after the ROC men’s team edged Japan for the top spot in the men’s final.

Great Britain edged Italy for bronze.

The Russian athletes collapsed in joy after Angelina Melnikova’s floor routine score assured them of the top spot.

The Americans hung in there for silver even without Biles. The 24-year-old U.S. star, considered to be the greatest gymnast of all time, huddled with a trainer after landing her vault. She then exited the competition floor with the team doctor.