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

The Russian gymnasts posted a team score of 169.528, ahead of the U.S. in second place at 166.096. The gold is the first for the Russians 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 won 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.

Biles returned several minutes later. The reigning Olympic gymnastics champion took off her bar grips, hugged teammates Grace McCallum, Sunisa Lee and Jordan Chiles before putting on a jacket and sweatpants.

“Simone Biles has withdrawn from the team final competition due to a medical issue. She will be assessed daily to determine medical clearance for future competitions,” USA Gymnastics said in an official statement.

The Americans were forced to finish the rest of the competition without her, severely hampering their bid to claim a third straight Olympic title.

The U.S. began finals on vault, with Biles going last. She was supposed to do an “Amanar,” a vault that begins with a roundoff back handspring onto the table followed by 2 1/2 twists. She seemed to change her mind in mid-air, doing just 1 1/2 twist instead.

She walked off the podium and was tended to by team doctor Marcia Faustin before making her way out of the arena. USA Gymnastics did not specify the nature of Biles’ medical issue.

Biles is scheduled to defend her Olympic title in the all-around final on Thursday. She also qualified for all four event finals later in the Games.

Whether she will get that opportunity remains to be seen.

Biles arrived in Tokyo as the unquestioned star of the Games but struggled, at least by her high standards, during qualifying. In a social media post on Monday, she admitted she felt like the weight of the world was on her shoulders and that the Olympics “were no joke.”

Biles won five medals in Rio de Janeiro five years ago and had a chance to actually top that after advancing to all five finals. It remains to be seen whether she will be available for the all-around final on Thursday night and the event finals later in the Games.