Background Data on the clinical utility of coronary computed tomography angiography–derived fractional flow reserve ( FFR _CT ) are sparse. In patients with intermediate (40–70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFR _CT testing with downstream utilization of invasive coronary angiography ( ICA ) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization). Methods and Results This was a single‐center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFR _CT “implementation” (n=800) or “clinical use” (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFR _CT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference: −4.2; 95% CI, −6.9 to −1.6; P =0.002). In patients referred to ICA , findings of no obstructive coronary artery disease decreased (−12.8%; 95% CI, −22.2 to −3.4; P =0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3–24.9; P =0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3–44.4; P <0.001) after clinical adoption of FFR _CT . Conclusions Replacing adjunctive myocardial perfusion imaging with FFR _CT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.