A CT-based clinical decision support system provides coronary decision support. With or without CT-FFR, a machine learnt predictor predicts the clinical decision for the patient based on input from various sources. Using the machine learnt predictor provides more consistent and comprehensive consideration of the available information. The clinical decision support may be provided prior to review of coronary CT data by a radiologist and/or treating physician, providing a starting point or recommendation that may be used by the radiologist and/or treating physician.