Meryl Davis and Charlie White won ice dance gold for the United States at Sochi 2014 as Britain's Penny Coomes and Nick Buckland finished 10th.
Davis and White beat Tessa Virtue and Scott Moir, Canada's defending Olympic champions, by 195.52 points to 190.99.
Coomes and Buckland - skating less than four months after he had undergone heart surgery - met their top-10 target with an overall score of 151.11.
Davis and White are the first ice dance gold medallists in US history.
Russia's Elena Ilinykh and Nikita Katsalapov won bronze with 183.48.
The Americans train alongside their Canadian rivals and the battle for the Olympic ice dance title in Sochi had long been a head-to-head contest between the two.
Some Canadian observers claimed Virtue and Moir had been under-marked in their short dance on Sunday - but Davis and White produced a peerless free dance to add Olympic gold to their 2013 world title, by a reasonable margin.
Nottingham's Buckland, 24, had surgery in October to cauterise a nerve which was causing a racing-heart condition known as tachycardia.
His heart had reached 270 beats per minute during previous events, such as last year's World Championships, where the Britons finished 13th.
Coomes and Buckland had gone on to win European bronze, their first major medals, with a career-best score of 158.69 in January - despite just six weeks' training post-operation.
While the judges decided they had not matched that performance in Sochi, their Michael Jackson-inspired routine roused a Russian crowd and the duo confirmed they will now target a medal at the 2018 Winter Olympics in Pyeongchang, South Korea.
Tenth marks an improvement of 10 places since the Britons finished 20th on their Olympic debut at Vancouver 2010, where team-mates Sinead and John Kerr - who subsequently retired - were eighth for GB.
"It is good to know that you have come off and have nothing left, you have given it all out there and that is what we wanted to do," said Buckland.
"No matter what the marks, the performance, whatever - we wanted to give everything we have had and we did that."