But they are moving into 3D, such as using drone photogrammetry to map cities at once: https://pro.arcgis.com/en/pro-app/2.8/help/mapping/layer-pro...
Sometimes those 3D layers are built from simple extruded polygons, other times they are more detailed meshes. But AFAIK even the most complex don't typically approach CAD complexity. More like the 3D buildings you see in Google Street View or the old Microsoft Flight Simulator.
Any GPU capable of running an Unreal Engine game should be able to handle that sort of stuff.
But it's really cool to see them going this way. It's always been a dream to play a AAA game in a real-world city (kinda like Watch Dogs or GTA) but where you can import any city you want.
You can already kinda do this with terrain with Cesium for Unreal (https://cesium.com/platform/cesium-for-unreal/) or for other games like Cities Skylines (https://en.number13.de/cities-skylines-how-to-import-heightm...), but I think those typically are limited to basic heightmaps.
Being able to translate not just buildings, but hydrology, vegetation, population density, etc. all from public GIS data, and simulate a whole game from them...? That'd be really awesome.