A computed tomography (CT)-based clinical decision support system provides fractional flow reserve (FFR) decision support. The available data, such as the coronary CT data, is used to determine whether to dedicate resources to CT-FFR for a specific patient. A machine-learnt predictor or other model, with access to determinative patient information, is used to assist in a clinical decision regarding CT-FFR. This determination may be made prior to review by a radiologist and/or treating physician to assist decision making.