Austria's double Olympic champion finally wins on the Stelvio from team-mate Vincent Kriechmayr and Urs Kryenbuehl.
Matthias Mayer claimed his first Bormio downhill victory in a thriller on the Stelvio on Wednesday (30 December).
Austria's Sochi 2014 downhill gold medallist and PyeongChang 2018 Super G champion had been second behind Dominik Paris on two previous occasions, but finally made the top of the podium for his 10th Alpine Ski World Cup victory.
On the second longest downhill course on the calendar, the skiers had their bravery and stamina tested thoroughly with Mayer taking his first win of the season by just 0.04s from team-mate Vincent Kriechmayr who was also second in Tuesday's Super G.
Swiss racer Urs Kryenbuehl was just two-hundredths further back.
Italian hero Paris, still working his way back to peak fitness after rupturing his anterior cruciate knee ligament in January, gave it everything in his bid for a fifth consecutive Bormio downhill victory.
The King of the Stelvio ended up just 0.13s off the pace in fourth.
But it was a story of what might have been for the American who looked on course for his second win in 24 hours having somehow recovered from landing on the seat of his pants from the early Rocker jump.
Cochran-Siegle - quickest in both weekend training runs - was seven-tenths up at the last time check, but almost fell on a late turn as the arduous course took its toll and ended up three-tenths down in seventh place.
The 28-year-old admitted to US Ski and Snowboard Team, "I didn't quite give it the respect it needed."
Marco Odermatt was 12th for his best finish in a World Cup downhill.
Kilde's performance saw him go top of the overall World Cup standings.
Norway's reigning champion now leads Alexis Pinturault by three points having trailed by 37 at the start of the day.
He also stays top of the downhill World Cup series but his lead over the chasing pack, now headed by Mayer, is down to 32 points.