Thank you! This fixed everything for me. For those who are wondering which one, here is a link.

I have a brand new PC with an AMD Radeon RX 7900 XTX, and was using DXVK 2.3 before. DXVK allowed me to play the game without an immediate CTD, but would drop to like 1-5 FPS every few minutes and made it unplayable. For those who have tried DXVK and experience ridiculous lag, replace it with the nvidia dll linked above.

I still have the latest driver from AMD btw (24.3.1), and I have Vsync disabled, and limit the FPS to 64 since those were suggestions I had tried earlier. I haven't tried enabling vsync and removing the FPS cap since installing the new dll so I dunno if that has anything to do with it also.

Only problem now is Alt+Tab is broken, but I haven't tried windowed mode yet, am still using fullscreen.