The best PCSX2 settings for GTA San Andreas depend on your PC. The safest setup is Vulkan, 2x or 3x internal resolution, Bilinear PS2 texture filtering, and safe speedhacks.
For lag and stutter, fix performance before improving graphics. If driving feels slow or audio cuts, lower the resolution, turn off HD textures, and test the game at normal 30 FPS first.
60 FPS can feel smoother, but it is not always the best option. Use it only when the patch matches your GTA San Andreas version. If it causes mission bugs or weird gameplay, switch back to 30 FPS. Stable gameplay is better than chasing higher FPS.