The 23-year-old Australian's victory enabled McLaren to replace Red Bull as leaders of the constructors' championship, ending the champions' two-year dominance.
The race of attrition ended under a Virtual Safety Car following a spectacular late collision between Carlos Sainz of Ferrari and Red Bull's Sergio Perez as they battled for third.
George Russell finished third for Mercedes ahead of title-chasing Lando Norris in the second McLaren, who fought from 15th on the grid to beat three-time champion and series leader Max Verstappen of Red Bull, who was fifth.
"Well, that was the most stressful afternoon of my life," said Piastri on team radio.
"A big move! Thanks for the car! What a day that was! Thanks everyone."
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