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It does not matter if I have DXVK installed or not, either way it drops to 50 and stutters extremely besides the fact that it should run normally.
For me personally, after trying literally everything out there, turning the steam overlay back ON is what fixed it for me. I was having the exact same issue as the above until I did this.
As for the other things, GTAIV is weird with monitors with a higher refresh rate. Your best bet is to use Nvidia control panel to lock the game between 58-60 fps.
Vsync for some reason made the game run horribly, but I think it's because my monitor is 244hz. You can try with this on and off.
There's of course other downloadables and mods. The video I'd recommend following and THEN trying the above fixes is this one:
https://www.youtube.com/watch?v=UuXVYUGJ45Y