Education systems in East Asia consistently score high in international large-scale assessments such as the Program for International Student Assessment and the Trends in International Mathematics and Science Study. Understanding the factors behind this success is important for policymakers and educators aiming to improve mathematics education outcomes worldwide. This study provides a systematic review of research examining the determinants of high performance in the education systems of Singapore, Hong Kong, Taiwan, and Macao. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, relevant studies published between 2000 and 2025 were identified from major academic databases. After screening and quality appraisal with the Mixed Methods Appraisal Tool (MMAT), 30 studies were included in the final analysis. Data from these studies were extracted and synthesized to identify common themes that explain the strong performance of these systems in international mathematics assessments. The findings highlight four major factors linked to high student achievement: rigorous teacher preparation and ongoing professional development, coherent, mastery-oriented mathematics curricula, cultural values that support effort and academic achievement, and coordinated governance structures that align curriculum, instruction, and assessment. These elements work together to create educational environments that foster deep conceptual understanding and strong problem-solving skills among students. The review suggests that improving mathematics education requires a systemic approach rather than isolated reforms. Although educational contexts vary across countries, the principles identified here offer useful insights for policymakers and educators seeking to enhance mathematics teaching and learning.